HomeMy Public PortalAbout5420 SULTANA AVE_Relocation__ • APPLICATION FOR RELOCATION BUILDING PERMIT
DrMON OF B=RIG AND SAMT BUILDING
Dep�pp{ of County En9 ADDREBS�
County of Lw Angalm y-
7EAEE11 JOHN A LAMBIE,COUNTY ENGINEER LOCALITY AO
DoE TY 11 EE CASSATT D GRIFFIN SUP T OF BUILDING NEAREST
CROSS ST
FOR APPLICANT TO FILL IN, DISTRIUTN GROUP rrPe HeWER MAP
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PROPOSED ON
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NUMBER -76 / HWY YES NO•
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CONTRACTOR` O V C III NO 61
GGH DATE RED D
ADDRESS .ee Ir G DEPOSIT* r
BUILDING TEL M V
CONTRACTOR NO I DATE INSPECTOR 9 SIGNATURE
ADDRESS FOUNDATION LOCATION -32-1r'
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pp RESENT / FORMS MATERIALS J I //
USEOF C4 FRAME FIRESTOPH
BUILDING v . L` "�- BRACING BOLTS
PROPOSED
USEOF , FURNACE LOCATION
BUILDING n �' GAB VENTS DUCTS
I
LATH INT
SO FT e7 7 NO OF
SIZE ROOMS STORIES LATH EXT
WALLeF ROOF
COVERING 1 i" COVE 1 O OC- HOUSE NUMBER COR-
LEGAL LOT NO I BLOCK REGI AND POSTED
DESCRIPTION
AL
TRACT O� '0 RIOT ENGINEER
SIZE F OT OW FBLLOGT WORK COMPLE'T'ED
-USE OF / SURETY BOND /.
EXISTING BLDG 2 t .,T/1 B . C NO OF EL SED �d
MI IEE
1 HEREBY ST TE HAT THE INF RM O 1 — I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIN
CORRECT APPLICATION AND STATE THAT THE ABOVE IS CORRECT
SIGNATURE OF AND AGREE TO COMPL WITH ALL COUNTY ORDINANCES
APPLICANT AND STATE LAWS RE LATING BUILD�N
I TION ✓/YI
ADDRESS fwc p( i BIGNATU RE OF
PERMITTEE
VALUATION S P C $
/
496
O PEB ADORES
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JOHN A LAMBIE COUNTY ENGINEER CLYbE N DIRLAM CHIEF RI EFIG INSPECTOR
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