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JGM444-CE !875 4-68 MISCELLANEOUS APPLICATION
COUNTY OF LOS ANGELES
A
DEPARTMENT OF COUNTY ENGINEER ieo ESS
BUILDING AND SAFETY DMSION
JOHN A LAMBIE COUNTY ENGINEER LOCALITY
COLEMAN W JENKINS SUP T OF BUILDING NEAREST
CRO T
FOR APPLICANT TO FILL IN DISTRICT n0 GROUPTYPE PROCESSED BY
CONST
BUILDING
ADDRESS MAP QQ AY
XO G (C IA(CINC CLE) STATE MAJOR^-FONJ LOCAL
LOCALITY _ USE ZONE SPECIAL-CONDITIONS_ — ---' –
NEAREST
CROSS ST
LEGAL �//, REQUIRED YARD HWY STREET NAME E%IST
DESCRIPTION LOT NO.Av LOCK SETBACK WIDTH
PRONT
NO OF BLDOS / P L
TRACT NOW ON LOT SIDE
USE OF
S12E OF LOT EXISTING RLPCI1
OWNER
MAIL
ADOR ESS 4a 24tel�
TEL
CITY O
APPLICATION FOR C)
OCCUPANCY OG
INSPECTION SAFETY PERMIT O
U
TRAILER USE �
N
USE OF STRUCTURES OR DEVICES ?
LIMITED TIME USE
v�
DAT! DALE
FROM TO
APPROVALS DATE INSPECTOR S
SIGNATURE
OCCUPANCY APPROVAL
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS GROUP OCC LOAD
APPLICATION AND STATE THAT TME ABOVE IS COR
RECT AND AGREE TO COMPLY WITH ALL COUNTY TRAILER USE
ORDINANCES AND STATE LAWS.7L INC SUCH
OR AS I
W NDIC AT ON
SIGNATUREOF SAFETY PERMIT
PERMITTEE TEMPORARY
STRUCTURE APPROVED
ADDRESS TEMPORARY
STRUCTURE REMOVED
FEE S/,f- �a FINAL APPROVAL ! d
APPLICATION
I TIDATIO Clt M O CASH JOHN F LEWIS, PRINCIPAL STRUCTURAL EN
(NOT APERMGINEER
PERMIT VALIDATION CK M 0 CASH
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