HomeMy Public PortalAbout5108 PERSIMMON AVE_Certificate of Occupancy__ Pr
WRWi1jPLic
ATIONN FOR .00CUPANCY INSPECTION
FOR APPLICANT•TO FJLL.IN BUILDING
-(P'rint or type only) ADDRESS
BUILDINGLM LOCALITY
AD D R ESS �d A/L3 A
NEAREST
CITY , �J • ZIP fl O CROSS ST.
SIZE OF LOT i � NO..OF BLDGS. ASSESSOR
7s NOW ON LOT MAP BOOK PAGE PARCEL
DISTRICT- TYPE FIRE PROCE SED BY
TRACT 024L 7 BLOCK LOT NO._F4" CONS . ZON
OWNER TE:
(� Vs/^ NOVve��/�� USE ZONE NO' (�
ADDRESS
SPECIAL
T CONDITIONS
CITY / w G+ ZIP /'71)p'� BLDG.SETBACK FROM
' SIZE-OF / ANO.OF / FRONT PROP.LINE OF (STREET)_
EXISTING-BLDG.- le g STORIES
HIGHWAY +. YARD- TOTAL SET BACK FROM TYPE OF IXISTaVG
PRESENT USE OF.BUILDING FRONT PROP.LINE HIGHWAY WIDTH
BLDG.SET BACK FROM
NO.PARKING. ^ SIDE PROP;LINE OF (STREET)I
SPACES PROVIDED V
HIGHWAY + YARD= TOTAL SET BACK FROM TYPEOF Exiff'aVG
SIDE PROP. LINE HIGHWAY WIDTH
REASON FOR INSPECTION REQUEST + —
eShJ / CORFVER CUTOFF YES:. NO
el el
OCCUPANCYGROUP OCCUPANT -
AS VERIFIED
LOAD •-
EXIT HARDWARE:
PROPOSED MAX.OCC. NO SPEC. KNOWL. ❑
NO.OF EXITS-
I HEREBY ACKNOWLEDG AT I HAVE READ THIS PA EVICES ❑
APPLICATION.AND STAT AT THE ABOVE IS COR-
RECT.
PARKING: REQ'.D PROVIDED
SPACES
SIGNATURE OF-
APPLICANT FINAL
DATE
ADDRESS
000. A41P.4-owt".vAl,
7 Within ttie scope of this Inspec-
tion the Building .Offi.Cial may .
approve minor corrections or
ZIP I alterations of an existing struc-
ture involving work of a build- PERMIT FEE
O o IV plumbing, mechanical or
�-PONE ctrvnature. ISSUANCE FEE
Q kcal
��6� DoN
TOTAL FEE r ®f)
e
-=" A`PPL-•••CCATION VALIDATION GK.• M.O. CASH
-47 O O N CA
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