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T•AG•8ACK*8O21096APPLICATION FOR BUILDING PERMIT
BUILDING AND SAFETY DIVISION ADOREBH
Departinmt of County Engin
County of Los Angelos LOCALITY
JOHN A LAMBIE COUNTY ENGINEER NEAREST
CASSATT D GRIFFIN SUP T OF BUILDING CROSS ST.
FOR APPLICANT TO FILL IN DISTRICT NO I G17
ROUP nP SEWER MAP
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CONST
BUILDING ( 6 _
ADORE" STATISTICAL CLASSIFICATION
CLASH NO UNIT
DWELL R
LOT NO • BLOCK MAP STAT!
NUMBER HWY YES
TRACT USE ZONE SPECIAL
NO OF SLOGS / CONDITIONS
SIZE OF LOT NOW ON LOT
USE OF
EXISTING BLDG BUILDING YARD HWY STREET NAME FUST
SETBACK WIDTH
OWNER FRONT /I
MAIL uu tt '
ADDRESS
TEL P L
m NO INSPECTION RECORD
ARCHITECT OR TEL
ENGINEER NO
i• /v0 6Nf C 4ot S _
ADDRESS ity rL '
TEL
CONTRACTOR NO
O d
ADDRESS 4
DESCREMON OF WORE
I
NEW D AL"ER RlPAIRDEMOLISH �f
Sq FT NO OF NO OF
SIZE I STORIES FAMILIES
USE OF STRLWTURIZ
0
VAPPROVALB
SIGNATURE OF
APPLICANT DATE INSPEC70URE
ADDRESS FOUNDATION LOCATION
FORMS MATERIALS
PEE C • PRAMS FIRE STOPS
I PBRACING BOLTS
VALUATION f Q FURNACE LOCATION
FE! GAS VENT DUCTS
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH INT
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALI, COUNTY ORDINANCES AND LATH EXT
STAT! LAWS REG U IN UILD NO ONHTRUCTION
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED
ADDRESSFINAL
JOHN A LAMBIE COUNTY ENGINEER CLYDE N DIRLAM PRINCIPAL STRUCTURAL EN
PLAN CHECK VALIDATION CK mo CATH PERMIT VALIDATION CK M O cAex
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