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CE#803(REV 11/78)
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APPLICATION FOR-BUIUDING PERMIT
COUNTY OF LOS ANGELES _ _ BUILDINGANDSAFETY ..
LDING
FOR APPLICANT TO FILL IN ADDRESS J .3-3 -
BUILDING /
ADDRESS LOCALITY / c
�_ NEAREST
CIT F ZIP CROSS ST
Q NO OF BLDGS ASSESSOR
Q� Q
SIZE OF LOT e G NOW ON LOT '0 IMAPBOOR + PAGE r 4 PARCEL
DISTRICT GROUP TYPE } FIRE P@OCESSeD BY
TRACj343/y 11 7 BLOCK 4 LOT NO/-4 Q CONST']'�� ZONE r F
OWN //.tQi� N�Ps'�JT �/�a 3 --ice- 1
STATISTICAL CLASSIFICATION SEWER MAP
ADDRES _ �/'� t
y`'� '� �'�� CLASS NO DWELL UNITS BK e
PG
CITY- ,,:�,,V A!- ZIP -
ARCHITECT OR TEL VALUATION $ D/ 0010ENGINEER - - tNO i
ADDRESS _ _ BLDG SETBACK FROM
TE y_ FRONT PROP LINE OF (STREET) S
CONTRA //1.� Nd�7�Z HIGHWAY + YARD TOT SETBACK FROM TYPE OF EXISTING °
n LIC - FR NTAR9P LINE HIGHWAY WIDTH
ADDRESS ��T^�Z� NO
LIC - t + _
CITY CLASS -
BLDG SETBACK FROM h
CONSTRUCTI X36- _ r / - SIDE PROP LINE OF (STREETI t
NAME AN //"" CY TOTALSETBACK FROM TYPE OF EXISTING
HIGHWAY t YARD = SIDE PROP LINE HIGHWAYI WIDTH
AYM&
SQ FT NO OF 7 NO OF CHECK + = V
SIZE g STORIES �r FAMILIES ' "ONE SE 0+
USE ZONE MAP
DESCRIPTION OF WORK NEW i/— NO � LpQ
f ADD ❑ d o0 SPECIAL
CONDITIONS + y�j
ALTER ❑ FINALS. / - ��� B _p�.� a
REPAIR ❑ DATE o �„par g 2 6 A
USE OF DEMOLF
EXISTING BLDG e ,A�� - _ 2 #X45
r,
APPLICANT,,/ _ TEL t 0 ` Y
IPRINTlmE(, /�r4/� NOf�/� t BY(SIG � .HEREBY ACK LEDGE TH 1 HAVER D THI PLICATION AND STATE �` uY 2 THAT THE ABO S CORRECT D AGREE CO WITH ALL ORDINANCESUAND LAWS REGULATING BUILDING CONSTR CTION ERTIFY THAT IN DOING THE �/� to WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF PENSABONCORDIE O THE STATE OF CALIFORNIA IN RELATING TO WORKMEN SCOM � zQ r
SIGNATURE OF
PERMITTEE
ADDRESS CD o N 4t �z o W -�
TEL .r _ o a 0-- %`^�F o 0 o i
CITY NO --" ft:- P o .p No 0 -. o No
PC Fee S Z 77 ZD Permlt Fee ` iM OD o N > !o o
Cb CJI (A o OD OD N
O O O —� S O N '"�7
Issuance Fee D O 1=) O+ CA7, .. CH s H -
Total Fee