HomeMy Public PortalAbout4906AGNES AVE_Building (6) I
APPLICATION FOR BUILDING PERMIT
PPL?CANT TO FILL IN (Prm;ortype only)
" COUNTY OF LOS ANGELES
O 6 Al. A rE c - DEPARTMENT OF COUNTY ENGINEER
CITYow ,Cf /TzIP �/- BUILDING AND SAFETY DIVISION"
NIF OF BLDGS r BUILDING
SIZE OF LOT ' NOW ON LOk3 ADDRESS
V."—
TRACT BLOCK LOT NO LOCALITY
TEL NEAREST
OWNER L(1 NO CROSS ST '
ASSESSOR
ADDRESS %:A/K MAP BOOK PAGE PARCEL
DISTRICT ROUP T PEFIRE PROCESSED BY
CITY ZIP ONST Z
ARCHITECT OR TEL
ENGINEER NO, STATISTICAL CLASSIFICATIONSEWER MAP
ADDRESS CLASS NO DWELL UNITS y 7. BK 5 PG
TEL
CONTRACTOR NO ZONE I MAP
LIC rPFE
ADDRESS NO IAL
LIC DITIONS
CITY CLASS ROAD DEPARTMENT APPROVAL REQUIRED- YES ❑ NO ❑
CONSTRUCTION ENDER
NAME AND BRANCH BLDG SATBACK FROM a
FRONT ROP LINEOF ' (STREET) '
ADDRESS CITY TOTAL SETBACK FROM TYPE(F EXISTING
SQ FT ? NO OF NO OF CHECK HIGH Y + YARD = FRONT PROP LINE HIGHWAY WIDTH
SIZE 3 STORIES FAMILIES ONE }
DESCRIPTION OF WORK NEW ❑ O
ADD BLDG SETBACK FROM n
SIDE PROP LINE OF r (STREET) O
ALTER ❑ TOTAL SE BA K TYPE OF EXISTING w
n/6 "o-tQ HIGHWAY + YARD = SIDE PROP LINE H Y WIDTH h
USEOF REPAIR ❑ Z
EXISTING BLDG DEMOL C3 +
APPLICANT TEL CORNER CUTOFF YES ❑+ NO ❑
(PRINT) NO
IN OPEN SPACE YES ❑ NO ❑
BY(SIGNATURE)
IN COASTAL PERMIT ZONE YES ❑ NO ❑
VALUATION -67b /
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE �L ~, CdV � Id `�5� `
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES I��� ",�" ^ �J�
AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE /I/
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF
PENSAT ON INSURANCE STATE OF CALIFORNIA IN RELATING TO WORKMEN S COM
SIGNATURE OF
PERMITTEE
ADDRESS 9Q 6
CITY `TEL
NO ��' DATEFINAL � /�� 7/ BY
MAKE CHECKS PAYABLE TO FPC EE $ f C� (•��/ FEET
HARVEYT BRANDT COUNTY ENGINEER
PLAN CHECK VALIDATION - CK M o CASH PERMIT VALIDATION CK o CASH
4 1 d+L-fiEC I.? 5
a r
®s 76A638A CE#803 3 75
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