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78A68A�tE*809 7 SGAPPLICATION FOR (BUILDING PERMIT1
BUILDING AND SAFETY DIVISION I BUILDING
ADDRESSDepartment of County Engineer !
County of Los Angeles LOCALITY
JOHN A LAMBIE COUNTY ENGINEER I N AREST
YL CASSATT D GRIFFIN SUP T OF BUILDING CROSS ST
FOR APPLICANT TO FILL IN DISTRICT NO GROUP TYPE SEWER MAP
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�J ]� .5– -BUILD
CONST 4a J
ADD EISS of /�' 44 / STATISTICAL SIF[CATION II
CLASS NO DWELL UNITS
LOT NO i BLOCK NUMAPMBER D/6 STATE yES O
HWY
TRACT jj `� � � US�ZOSPECIAL x
h NO OF BLDGS �
CONDITIONS f
SIZE OF LOT /D(J �Z�J I NOW ON LOT
USE OF
BUILDING r _
EXIST
EXISTING BLDG Gf�� d4
YARD HWY STREET NAME
SETBACK WIDTH
OWNER 114.24
� / / y� FRONT
MAIL / % .2(O // &U fle 0 1-
ADDRESS Alt �!7 r SIDE
P L
CITY
TEL
T .2�7 IN PECTION RECORD
ARCHITECT OR TEL
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ENGINEER NO I/d
ADDRESS �o� 5Z aa�F I tK Q t+it` b1S /Y
TEL "�–
CONTRACTOR NO ti!
14- bA,11-14 Ll.
ADDRESS
DESCRIPTION OF WORK ?���
NEW ADD ALDER (f REPAIR DEMOLISH
SQ FT Ix NO OF NO OF
SIZE STORIES ' FAMILIES -
USESTRUCTUR
E/ud/JE L /�L'IBC/r/fD 6AGE /�,� ;' T
O S APPROVALS
SIGNATURE OF
APPLICANT DATE INSPECTOR S SIGNATURE
ADDRESS y�f E/�J T FGUNDATION LOCATION
FORMS MATERIALS
$ P C $ FRAME FIRE STOPS h�
t"`!lull FEE _BRACING BOLTS
VALUATION $ FURNACE LOCATION a
FEE GAS VENT DUCTS /
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I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP LATH INT I� G
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDI NCES AND LPTH EXT
STATE LAWS REGU TI IG ILDING RUCTION —
? SIGNATURE OF HOUSE NUMBER COR
PERMITTEE .JOW4ti RECT AND POSTED
ADDRESS FINAL r-
IOHN A` LAMBIE COUNTY EN (NEER F F CLYDE N DIRLAM P INC(PAL STRUCTURAL (NEER w
PLAN CHECK VALIDATION CK M O j1O CASH PERMIT VALIDATION CK m 0 CASH
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