HomeMy WebLinkAbout1812 BUTTERS RD; ; 70-456; Permit1 BUILDING PERMIT APPLICATION /;" IT
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I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT THE GRANTING OF A PERMIT DOES NOT
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PRESUME TO GIV'E AUTHORITY TO VIOLATE OR CANCEL THE
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE1
Applicant to complete numbered spaces only.
I JOB ADDRESS \
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LOT NO. BLK TRACT LEGAL (OSEE ATTACHED SWEET) 1 DESCR.
I
I I I
OWNER MAIL ADDRESS ZIP PHONE
m, ARCHITECT OR DESIGNER MAIL ADQRESS PHONE LICENSE NO.
I
4
5
ENGINEER MAIL ADDRESS PHONE LICENSE NO.
LENDER MAIL ADDRESS BRANCH \i 6
USE OF BUILDING
I I10 Change of use from I Change of use to I
(29 PLANCHECKFEE /A/,/?# I PERMIT FEE '1 o*rj 11 Valuation of work: $ 1- I 9+=
Occupancy SPECIAL CONDITIONS: Type of
Const. Group Division 19)
Size of Bldg.
(Total) Sq. Ft
No. of I Stories
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
Form 100.1 9-69
INSPECTOR
REORDER FROM: INTERNATIONAL CONFERENCE OF BUILDING OFFICIALS 0 60 SO. LO5 ROBLES 0 PASADENA. CALIFORNIA 91101