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A # -APPLICATION FOR BUILDING PERMIT F E
COUNTY OF LOS ANGELES BUILDING Z/�.T
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY T ®ce Grp ° a 4
JOHN A LAMBIE COUNTY ENGINEER NEARESTy ! I
CASSATT D GRIFFIN SUP T OF BUILDING CROSS ST 400 G/ A _
DISTaLCT NOG P BY
TYPE
FOR APPLICANT TO FILL IN I CONS I L.
BUILDING /I G Q/ /�g�
ADDRESS STATISTICAL SSIFICATION EWER MAP
T9 ,7 C+r/V
LOT NO � 00,0��� CLASS NO DWELL UNITE
E B)5K MAP STATE YE NO
xNUMBER D HWY
TRACT - USE ZONE SPECIAL
NO OF BLDGS DITIONS
USE OF E
SIZE OF LOT NOW ON LOT
BLD (!Pt y
ff��
EXISTIN
S INE YARD STREET NAME EXIST
OWNER /reE ,� S�/ n� eETBACK /��
WIDTH
AMAILDDRESS T % ��G-�(IL�J FP
OL T r�Y/IVV"�
SIDE
TEL,41-74/4 P L , I
CITYrjC& L r NO 7�s
ARCHITECTOR TEL INSPECTION RECORD
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ENGINEER NO
ADDRESS r
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CONTRACTORg0'414.OflRy O0Q
ADDRESS . J O w Imo/
DESCRIPTION OF WORK
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NEW ADD ALTER REPAIR' DEMOLISH
' .
$IT—FT3 NO OF NO OF
SIZE 5� STORIES FAMILIES
USE OF STRUCTU E +
%ICL$ "D :57;
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SIGNATURE OF .fid APPROVALS {
APPLICANyT� �
ADDRESS,
�E� r1�CF.r �S FOUNDATION LOCATION DATE INSPEGFORS- IcNATURE
FORMS MATERIALS
$ 1 / )� � � p C B FRAME FIRE STOPS r
FEE BRACING BOLTS
VALUATION ; FURNACE LOCATION
FEE GAS VENT DUCTS
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP LATH INT
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND -
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND LATH EXToll
I
STATE LAWS REGULATING UILDIN CONSTRUCTION
SIGNATURE OF * HOUSE NUMBER COR
PERMITTE RECT AND POSTED
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ADDRESS �(/// �� FINAL E
CLYDE N DIRLAM PRINCIPAL STRUCTURAL ENG ER
PLAN CEECK VALIDATION CK mo CA95H PERMIT VALIDATION CK M oCASH
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E.IC3670491, iA119 7- A, � � 900
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