HomeMy Public PortalAbout6058 GOLDEN WEST AVE_Certificate of Occupancy__ 76A66Z-C 477 '
T APPLICATION FOR ®CCUf KNCY INSPECTION
FOR APPLICANT TO FILL IN BUILDIN
(Print type o ly) ADDRE 6��8
BUILDING /'SC
ADDRESLOCALITY
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/ NEAREST
CITY ZIP (J CROSS ST.
SIZE OF LOT NO OF BLDGS. ASSESSOR,
NOW ON LOT MAP BOOK PAGE PARCEL
/ DISTRICT TYPE IFIRE P CE ED BY
TRACT / BLOCK CONS ZON
b T E O /�
OWNER NO. US ..; NE MAP "
/ / J NO.
A D D R E S b OC�J /`//��\/ I
SPECIAL
CITY ZIP 7" CONDITIONS
BLDG SET BACK FROM
SIZE F FRONT PROP.LINE OF (STREET)
EXISTING BLDG. CRIES
HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF oc07rwc
PRESENT USE OF BUILDING FRONT PROP.LINE HIGHWAY WIDTH
+ —
,SET BACK
NO PARKING SID PROP.LIINEOFOM (S'TREET)l QQ
SPACES PR ED U
TOTAL SETBACK FROM ITYPEOF ac]STING
HIGHWAY + YARD SIDE PROP LINE HIGHWAY WIDTH O
Z
REASON F INSPECTION REQUEST + — w
a
CORNER CUTOFF YES NO Z
OCCUPANCY GROUP
AS VERIFIED �� OCCUPANT
LOAD
EXIT HARDWARE
PROPOSED MAX OCC.
NO.OF EXITS NO SPEC. KNOW L. ❑
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS PANIC DEVICES ❑
APPLICATION AND STATE THAT THE ABOVE IS COR-
RECT.
PARKING REQ' P VIDED�
SPACES ,
SIGNATURE O -
APPLICANT FINAL ./ BY y/
AT �/ I
ADDRESS a
Within the scope of this in
spec- '
tion theBuilding Official may _
approve-minor corrections or
Zip / 9--'1 alterations of,an existing struc-
ture involving work of a build- PERMIT FEE
ing, plumbing, mechanical or
PHONE electrical nature.. ISSUANCE FEE
TOTAL FEE
APPLICATION VALIDATION CK. M.O. CASH
7 -7-AUG 28 2 2 D 6 f.0 0'a�