HomeMy Public PortalAbout5092 SULTANA AVE_Building__ - APPLICATION FOR
BUILDING PERMIT
FOR'APPLICANT TO FILL IN ADDRESS�� D / Z v e--
BUILDING
BUILDING
ADDRESS LOCALITY
NEAREST
CITY ZIP CROSSST
he OF SLOGSASSES50R
SIZE OF LOT NOW ON LOT MAPBOOK PAGE PARCEL
DISTRICT GRRQQjj��P TYPE FIRE ESSED Y
TRACT ..S�L'�11 BLOCK LOEL /L� UV G I TYPE � ZONE
OWNER NO ' STATISTICAL CLASSIFICATION SEWER P
ADDRESS, CLASSNO rt2 /--DWELL UNITS SK �PG
OTY R ZIP 115E ZONE MAP '
ARC ECT OR r TEL NO
ENGINEERNO _� SPECIAL
CONDITIONS
ADDRESS A ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑
EL
CONTRACTOR NO BLDG SETBACK FROM
LIC FRONT PROP LINE OF (STREET)
ADDR NO TOTAL SETBACK fAOM TYPE OF EXISTING
HIGHWAY + YARD a FROM PROP LINE HIGHWAY WIDTH
/1 LIC
CITY C CLASS
CONSTRIlC710N LENDE
NAME AND BRANCH BLDG SETBACK FROM V
ADDRESS CITY SIDE PROP LINE OF ISTREETI 0O
$O FT NO OF NO OF CHECK HIGHWAY + YARD _ TOTAL SETBACK FROM TYPE OF EXISTIN
SIZE STORIES FAMILIES ONE SIDE PROP LINE IHIGHWAY WIDTH
D IPTION OF WORK NEW
ADD ❑ CORNERCUTOFF YES ❑ NO ❑
ALTER IN OPEN SPACE YES ❑ NO ❑
REPAIR
USE OF IN COASTAL PERMIT ZONE YES ❑ NO ❑
EXISTING BLDG DEMOL
APPLICANT TEL ZEJp>z JDI SYs DEC, �1c
PRINT) NO
i
BY(SIGNATURE)
HEREBY EDGE THAT I HAVE READ L WITH AND LACES L
THAT THE A G CARRECi AND AGREE TO COMPLY WITH ALL ORDINANCES
AND LAWS TING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF
THE LABOR CODEOF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN SCOM .
PENSATPON CE
/f
SIGNATOR FINAL f' / �? BY G L�
PERMITTEE DATE Q{(
ADDRESS
ss
TEL PC FeejE Permit Fee
Cly
ITY Cat NO n
Issuance Fee
VALUATION S 6),Q
I Total Fee V
PLAN CHECK VALIDATION CK RIO c"H PERMIT VALIDATION c=_M o c"m
4 5 4 Y-(Uy 16 1 D 6 1.0 O ,Ls&
ms Zew�e ce Eeoae em L _ _