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7GA688A CE#803 756AP,PL.ICATION FOR BUILDING PERMITBUILDING
1
BUILDING AND SAFETY DIVISION ADDRESS -/ j /!w G[
Department of County Engmeer Q
County of Los Angeles LOCALITY
JOHN A LAMBIE COUNTY ENGINEER NEAREST ]
CASSATT D GRIFFIN SUP T OF BUILDING CROSS ST l
DISTRIO rROUP .TYPE SEWER MAP
FOR APPLICANT TO FILL IN �iK PG
CONST
BUILDING U
ADD-ADDRESS
fy3 STATISTICAL CLASSIFICATION
LOT NO BLOCK CLASS NO DWELL UNITS
MAP STATE YES O '
NUMBER HWY
TRACT �� USE ZO E SPECIAL _
SIZE OF LOT /�1/ �✓ `� NO OF BLDGS 9 CONDITIONS
NOW ON LOT
USE OF _
EXISTING BLDG B ILDING EXIST
SETBACK YARD HWY STREET NAME WIDTH
OWNER G FRONT
ADDRESS T
MAIL / a ��e� SIDE
/�JJ J TEL
�f X17
CITY -4& ( NO //1 / �v P L
ARCHITECT OJT TEL INSPECTION RECORD
ENGINEER - NO
ADDRESS
TEL
CONTRACTOR NO
v
ADDRESS
DESCRIPTION OF WORK
NEW ADD AL-ER REPAIR DEMOLISH
SQ FT � NO OF NO OF
SIZE STORIES / FAMILIES '
USE OF STRUCTURE
APPROVALS
SIGNATURE OF
APPLICANT c `' DATE INSPECTOR S SIGNATURE
ADDRESS �Z �7/9L� ✓ < FFORMSTM TERIIALSION
d P C SFRAME FIRE STOPS
FEE �- BRACING BOLTS j/
VALUATION S L FURNACE LOCATION
GAS VENT DUCTS
FEE �
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP LATH INT �' 1 `/�% �('��tr.�►_.-
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND oe
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
STATE LAWS REG L ING BUILD2 TRUCTION LATH EXT U
SIGNATURE OF HOUSE NUMBER COR
PERMITTEE RECT AND POSTED
ADDRESS I FINAL
IOHN A LAMBIE COUNTY ENGINEER CLYDE N DIRLAM PRINCIPAL STRUQTURAL-VKr6INEER
PLAN CHECK VALIDATION CK m o CASH PERMIT VALIDATION CK mo CASH
LU6947� APR R 1 1204