HomeMy Public PortalAbout5021AGNES AVE_Building (3) 76 iA ,E#'o3 �B APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES , BUILDING (_ A
" DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETX DIVISION LOCALITY
JOHN A LAMBIE, COUNTY ENGINEER
COLEMAN W JENKINS, SUP T OF BUILDING NEAREST y 1.�,VS
CROSS ST L- /`C
DIST T NO GROUP TYPE P CESSED BY
FOR APPLICANT TO FILL IN 0� -r- CONST
Print or type only) c
BUILDING /� `1vr STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS G_. �/ii CLASS NO DWELL UNITS O BK PG,
LOT NO 17 BLOCK USE ZONE MAP Ol '
__ NO
TRACT 4 CONDIT ONS
SPECIAL
NO OF BLDGS
SIZE OF LOT NOW ON LOT r
USE OF / �'_,,/^�
EXISTING BLDG ,+/ {tea 6" _�/ BLDG SETBACK FROM �' (STREET)
OWNER NOL 71 FRONT PROP LINE OF _
''^�j /� TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
ADDRESS 5o*Zi i W' &3� AvE HIGHWAY WIDTH FROM C L i
[-&c 6 O - - + 20 = �Z-c
CITY T
ABLDG SETBACK FROM
ARCHITECT OR TEL (STREET)
SIDE PROP LINE OF
ENGINEER NO TYPE OF EXISTING-SETBACK HIGHWAY- + YARD = TOTAL
ADDRESS -�} HIGHWAY WIDTH FROM C L
CONTRACTOR BO 1AI&I t NOL x,(.511 ! +
n �W`� yCUTO
ADDRESS 0 D9 v 6� NO 2�Lj G3 CORNER OFF YES ❑ NO ❑ U
CITY CVLOQ, CIT CLASS SEE REVERSE SIDE FOR SPECIAL APPRO LS
DESCRIP ION OF WORK �t a-
to to
NEW ADD ALTER REPAIR DEMOLISH
SQ FTNO OF NO OF
SIZE - STORIES I FAMILIES 1
USE OF
STRUCTURE
SIGNATURE OFjhb-A
APPLICANT {/V J
VALUATION $ �G�oO�-�
* APPROVALS DATE INSPECTOR 5 SIGNATURE
PMTFOUNDATION
FEE$ FEE $2 2 FORMS MATERIAAL ION
FRAME FIRE STOPS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS t
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS
BUILDING CONSTRUCTION 1 CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT
TION OF THE LABOR E OF THE STATE OF C FO NIA RELAT
ING TO WORKMEN $ NSATION INSU RAN
LATH EXT
SIGNATURE OF HOUSE NUMBER COR "
PERMIT TEE `'y ���� RECT AND POSTED ! + d
ADDRESS ' W FINAL 1
PLAN CHECK VALIDATION CK M o cnsH _ JOHN F LEWIS PRINCIPAL STR TURAL ENGINEER
PERMIT VALIDATION MO CASH
7505- DEC 4 1 D 2250"
- /