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76t(]�SA CE 80911 D7 APPLICATION FOR BLJ I,LD[NG PERMITt ,1"\ ,
COUNTY OF LOS ANGELES BUILDING �,
DEPARTMENT OF COUNTY ENGINEER j ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A LAMBIE COUNTY ENGINEER NEAREST
CASSATT D GRIFFIN SUP T OF BUILDING CROSS ST t `
DISTRICT :j GR P TYPE SEWER MAP
FOR APPLICANT TOTILL FILL INQ 1
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BUILDING N C, '-3
ADDRESS ``rrJ� V STATISTICA�CSSSIFICATION O
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CLASS NO DWELL UNITS
LOT NO 0 BLOCK MAP - STATE
NUMBER t HWY YES O
TRACT ) E ZONE SPECIAL '
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r NO OF BLDGS j CONDITIONS _
SIZE OF LOT I NOW ON LOT 1l,,
USE OF ood
EXISTING BLDG BUILDING r EXIST
` � SETBACK YARD HWY 'STREET NAME WIDTH
OWNER 1� �..J I FRONT /
MAIL \ P L d
ADDRESS SIDE
P L i
CITY TE INSPECTION RECORD
ARCHITECT OR TEL
ENGINEER NO /g�4W AW ti S
ADDRESS
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TEL �
CONTRACTOR NO
ADDRESS
DESCRIPTION OF WORK
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NE ADD ALTER REPAIR DEMOLISH
-� NO OF NO OF J 1_._0��� ������ S
SIZE STORIES FAMILIES
USE OF STRUCTURE ` / ' —�
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SIGNATURE O APPROVALS
APPLICANTk�NN n ,
DATE INSPECTORS N TURE
ADDRESS V 1 FOUNDATION LOCATION
FORMS MATERIALS
$ 1 P C FRAME FIRE STOPS
/ ���� FEE BRACING BOLTS
VALUATIONOCATIO
FEES �d FGAS VENTURNACELDUCTS N •/ o +
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP v
PLICATION AND STATE THATI THE ABOVE CORRECT AND LATH INT I
AGREE TO COMP TH ALL COU fi R NANCES AND
STATE LAWS ING BUI IN C NS O LATH EXT
SIGNATURE O c HOUSE NUMBER COR
PERMITTE RECT AND POSTED
ADDRESS AJ FINAL' �� -II_d f'c-
CLYDE N DIRLAM PRINCIPAL STRUCTURAL EN R
PLAN CHECK VALIDA ION CK mo CASH PERMIT VALIDATION cK mo CASH
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