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APPLICATION FOR BUILDI G PERM LI
COUNTY OF LOS ANGELES BUILDING 0DEPARTMENT OF COUNTY ENGINEER ADDRESS
ell BUILDING AND SAFETY DMSION LOCALITY
JOHN A LAMBIE, COUNTY ENGINEER
COLEMAN W JENKINS SUP T OF BUILDING NEAREST
CROSS ST
DIST�I T U TYPE D
FOR-APPLICANT TO FILL IN tt CONST
(Print ort e only) v '
BUILDING _ STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS t P CLASS NO DWELL UNITS BK Lj PG R
LOT NO BLOCK USE ZONE[SPECIAL
APOTRACT
NO OF BLDGS ONDITIONS
SIZE OF LOT ' NOW ON LOT
USE
EXISOTNG BLDG S QaAo;CF BLDG SETBACK FROM
TEL FRONT PROP LINE OF (STREET)
OWNER NO TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
' HIGHWAY WIDTH FROM C L
ADDRESS
CITY /� /� BLDG SETBACKFROM
ARCHITECT R TEL�jGG p ^ SIDEPROP LINEOF (STREET)
ENGINEER NO%7Z _���wL TYPE OF EXISTING SETBACK HIGHWAY + YARD 't= TOTAL
ADDRESS B1,,Ei '� HIGHWAY WIDTH FROM G L
TEL
+
CONTRACTOR NO 4 6 G O
ADDRES L /� NO L (" CORNER CUTOFF YES ❑ NO ❑ U
CITY 4,P A CLASS SEE REVERSE SIDE FOR SPECIAL APPROVALS
DESCRIPTION OF WORK
NEW) ADD ALTER REPAIR DEMOLISHtiul �f
FT NO OF NO OF '� V
SIZE STORIES FAMILIES
USE OF (2'
STRUCTURE fjdLAjoftl4la
SIGNATURE OF
APPLICANT
VALUATION$ 6 ��
APPROVALS DATE �^INs PECITOR 5 SIGNATURE
FEE p S FEE$ C,?1-7, 7✓ FOON FORMS I MATERIIALSON
FRAME FIRE STOPS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS
BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WO----
AUTHOR IZED
ORKAUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT 1
TION OF THE LABOR CODE OF TjNI
UNC
ALIFORNIA RELAT
INC TO WORKMEN S CO ENSATI
LATH EXT
SIGNATURE OF HOUSE NUMBER COR
PERMITTEE RECT AND POSTED
ADDRES FINAL J
JOHN
PLAN CHECK VALIDATION cK M o CASH _ PERIM VALIDATION T CK URMLENO C MO
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1 N It
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