332953 (SFD)NOTICE: THIS IS NOT A BUILDING PERMIT DISTRICT
APPLICATION TO CONSTRUCT' Permit No
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
284 199A 9/74 CANARY—FILE, PINK—APPLICANT
Own r Contractor_DmCJ�(jL1DSQH__
Addre z-0 A az Address_ Address -60 _K6 9-4- - -
City
Phone-346-J�14*___
Phone Phone
I (we) the undersigned, hereby certify and acknowledge that 1'(we) have read the application and agree that if Curb and Gutter, and
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Paving, and/or Dedication of right of way is required by the County of Riverside, the Riverside County Department of Building and Safety
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shall not make a Final Inspection until said requirements have been met. .1 am also aware that no work is to be done within the County R/W
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without c-cro h-.nt permit.
'e, it i s agreed that I (we) will not OCCUPY said property and will not cause said property b occupi u fit I (we) have
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complied with all laws of the County of Riverside and the State of California governing said property.
DATE SIGNATURE OF OWNER AND/OR AGENItK-
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Approval by Signature from the Following Departments Listed 82
Must Be Obtained Prior to the Issuing of a Construction Permit.
SPACE NO.
USE OF STRUCTURE
JOB ADDRE.SS SINGLE FAMILY DUPLEX
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�LEGA L D�fllpTrl OF PROPERTY�_� APARTMENTS AGRIC.
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COMMERCIAL INDUSTRIAL -
COMMUNIT Y. ALTERATIONS
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NO. OF SUBMITTED PLANS USE OF PERMIT 53—
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CASE NO.
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NO. OF PARKING SPACES REQUIRED OF BUILDINGS NOW EXISTING
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ZON z SETBAeKS: FRONT SIDE REAR
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GRA ERMIT REQUIRED? YES E) NO F-1 LOT SIZE
SETBACK ORDINANCE OF FEET REQUIRED ON EET
DATE� SIGNATURE OF LAND USE OFFICI
DEDICATION REQUIRED: YES El NO C1 NO. OF FEET --
&RB AND GUTTER REQUIRED: YES''El NO 171 —STREET
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CAN CURB AND GUTTER FEASIBLY BE INSTALLED? YES 0 NO 0
HAS AN ACCEPTABLE APPLICATION BEEN MADE FOR ENCROACHMENT PERMIT FOR DRIVEWAY AND STREET
IMPROVEMENT? YES 0 NO R
0
DATE SIGNATURE OF ROAD DEPT. OFFICIAI
SWIMMING POOLS PUBLIC
SEWAGE DISPOSAL
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F.00D ESTABLISHMENT
WATER POLLUTION REMARKS
FLOOD CONTROL—
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DIV OF HWY
YOUR PROPERTY MAY BE SUBJECT TO
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FLOOD. RIVERSIDE COUNTY ASSUMES
NO RESPONSIBILITY IN EVENT OF FLOOD.
284 199A 9/74 CANARY—FILE, PINK—APPLICANT