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76A688A CE»809,058 APPLICATION FOR BUILDING PERMIT 1
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COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS C
BUILDING AND SAFETY DIVISION LOCALITY r
JOHN A LAMBIE COUNTY ENGINEER NEAREST
CASSATT D GRIFFIN SUP T OF BUILDING CROSS ST
DISTRICT N"G�RO YPEP ESSED BYFOR APPLICANT TO FILL IN ONST yk
BUILDING [`r STATISTICAL CLASSIFICATION SYWER MAP
ADDRESS K G
CLASS NO DWELL UNITS Z
LOT NO O / S 2 BLOCK NUMB ER HWY YES O
USE ZONE
TRACT SPECIAL
NO OF BLDGS � CONDITIONS
SIZE OF LOT i O O O I NOW ON LOT
USE OF
EXISTING BLDG BUILDING YARD HWY STREET NAME EXIST
OQ SETBACK WIDTH
OWNER ` FRONT p /1
MAIL �P L p�
ADDRESS .;L AVa, W b SIDE
# TEL 'P L
CITY NO 6-0 INSPECTION RECORD
ARCHITECT GIR TEL —
ENGINEER NO <
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K
ADDRESS
4 a
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^ TEL '
CONTRACTOR D IE NO c
ADDRESS DESCRIPTION OF WORK4 `r Tw I hylal NAAIY P A->,/ �s
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NEW ADD ALTER REPAIR DEMOLISHNO OF NO OF
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SIZET 1,3„Z 3 r STORIES OFAMILIES
SUSE OF
TRUCTURE
SIGNATURE OF
APPLICANT _L Y-��
7 � � FOUNDATION LOCATION APPROVALS DATE c INSPECTOR S SIGNATURE
_ADDRESS
VALUATION
FORMS MATERIALSME FIRE
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$ O F-RACING BOLOTSS �R 2- a
PMT FURNACE LOCATION
F E FEE $ GAS VENT DUCTS ,1Z-(J/
O DAG
I HEREBY ACKNOWLED E T 1 HAVE READ THIS AP r
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND LATH INT r _1 A h-
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES ANDVdV
STATE LAWS REGULATIN BUILDING CONSTRUCTION LATH EXT
SIGNATURE OF HOUSE NUMBER COR- /
FERMI-EEr RECT AND POSTED
ADDRESS FINAL'
CLYDE N DIRLAM PRINCIPAL STRUCTURAL EER
PLAN CHECK VALIDATION CK M O CA6H PERMIT VALIDATION CK MO CAS
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