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78A6S8A CE#803 687 APPLICATION FOR BUILDING PERMIT �.
COUNTY OF LOS ANGELES BUILDING /
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A LAMBIE COUNTY ENGINEER NEAREST
CASSATT D GRIFFIN SUP T OF BUILDING CROSS ST
DISTRICT NO GROUP TYPE SEWER MAP
FOR APPLICANT TO FILL IN CONST K 1 OPS
BUILDING /
ADDRESS �l i i STATISTICAL/CLASSIFICATION
,,tom 1 CLASS NO • DWELL UNITS
LOT NO ♦J 7BLOCK MAPG') O HTV YE YES NO
�{- NUMBER Q�
TRACT Z E SPECIAL
NO OF BLDGSO ONDITIONS
SIZE OF LOT I 9— NOW ON LOT
USE OF
EXISTING BLDG BUILDING EXIST
YARD HWY STREET NAME
SETBACK WIDTH
OWNER L U/y/ FRONT
AMAIL
DDRESS 7r �� l P L D ������ �`_♦;/
�+ ^ SIDE
CITY �i "N Cs� �.L P L
NO
ARCHITECT OR TEL INSPECTION RECORD
ENGINEER NO
ADDRESS
,,I /4,e ja�S TEL /9L
CONTRACTOR NO
ADDRESS
DESCRIPTION OF WORK
F .</✓TFC O n/ OTr-(J WA G
NEW -- ADD ALTER REPAIR DEMOLISH
SQ FT NO OF NO OF
SIZE STORIES FAMILIE
USE OF STRUCTURE h t
SIGNATURE OF IJ APPROVALS
APPLICANT
DATE INSPECTOR S SIGNATURE
ADDRES FOUNDATION LOCATION Qy
/ FORMS MATERIALS //.
P C FRAME FIRE STOPS
FEE BRACING BOLTS
VALUATION S FURNACE LOCATION
FEE GAS VENT DUCTS .7
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP LATH INT
PLICATION AND STATE THAT THE ABOVE IS CORRECT ANDAGREE TO MP
Q� /
STATE LAWS rR YULATINGWITH L COUNTY U LDING CONST UE TION S AND
LATH EXT ` rl
SIGNATURE O ✓ HOUSE NUMBER COR
PERMITTE J� RECT AND POSTED
ADDRESS FINAL
JOHN A LA IE COUNTY ENGINEE CLYDE N DIRLAM PRINCIPAL STRUg4jJRAL ENGINEER
PLAN CHECK VALIDATIO cK M o CASH PERb= VALIDATION K M o CASH
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