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MISCELLANEOUS APPLI ATION
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING V
ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY '
JOHN A. LAMBIE. COUNTY ENGINEER
COLEMAN W.JENKINS.SUPT. OF BUILDING NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN DIs�tic�Ng,i ROUP YPE PR s B
�� NST.
BUILDING MAP HIGHWAY
ADDRESS N0. L (CIRCLE) STATE MAJOR SECOND LOCAL
LOCALITY fiaL
. USE Z000O���NE SP CLAL CONDITIONS
NEAREST a'
CROSS ST.
LEGAL REQUIRED YARD HWY STREET NAME EXIST.
DESCRIPTION LOT NO. BLOCK SETBACK WIDTH
FRONT
NO. OF BLDGS. P.L.
TRACT NOW ON LOT SIDE
USE OF P.L.
SIZE OF LOT y�- EXISTING BLDG.
OWNER ! 1Wq / , P
MAIL
ADDRESS
EL.
CITY n NO.
O
APPL CATION FOR
OCCUPANCY
INSPECTION SAFJ=TY PERMIT
7t 495�b
V
TRAILER USE pW
USE OF STRUCTURES OR DEVICES Z
vol /. c •'a u' rv�f��
LIMITED TIME USE
DATE DATE
FROM: TO:
APPROVALS DATE INSPECTOR'S
SIGNATURE
OCCUPANCY APPROVAL
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS OR OUP OCC. LOAD
APPLICATION AND STATE THAT THE ABOVE IS COR-
RECT AND AGREE TO COMPLY WI L COUNTY TRAILER USE
ORDINANCES A STA E LA G G SUCH
WORK AS INDICA D H EON
SIGNATURE OF r SAFETY PERMIT
PERMITTEE j' TEMPORARY
dj * STRUCTURE APPROVED
ADDRESS ( TEMPORARY
STRUCTURE REMOVED
FEE FINAL APPROVAL
APPLICATION VALIDATION JOHN F. LEWIS, PRINCIPAL STRUCT RAL ENGINEER
(NOT A PERMIT) CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
rrl� '1 51 69 JAH27 7 D 11.00~
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