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I 9'# APPLICATION �O R lJ I L®I IV G PERMIT'
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DIVISION OF BUILDING AND SAFETY BUILD 1 N G
ADDRESS (f
Department of County Engineer
County of Los Angeles LOCALITY i
JOHN A LAMBIE COUNTY ENGINEER NEAREST
CASSATT D GRIFFIN SUP T OF BUILDING CROSS ST Q
FOR APPLICANT TO FILL IN
DIST
IS 17_�NO GROUP ,TYPE SEWER MAP
`%L �d/ B P
BUILDING /� ��(( � . 1 ^ ` CONST
ADDRESS -52 f U til, /tet (�, /�/p-� NUM ER STATE
YES
LOT NO BLOCK USE ZONE SPECIAL
CONDITIONS
TRACT �3S 3,3�fU ` ,C /SQ I NO OF BLDGS BUILDING IJ D EXIST
SIZE OF LOT NOW ON LOT YARD HWY STREET NAME
SETBACK WIDTH
USE OF Ot S
EXISTING BLDG I� FRONT
_ P L
OWNER �p(�A, i Q I DR I A i/J SIDE
P L
MAIL
ADDRESS O TRACT DWELL I UNIT
5 INDUSTRIAL
TEL
CITY T pL C�Gf NO 1 DWELL 1 UNIT
6 PUBLIC BLDG
ARCHITECT OR TEL 2 DUPLEX / 2 UNITS
ENGINEER f5: RC1L,LiN.SNO3 APT UNITS 7 ADDN ALT ETC
ADDRESS 4 COMMERCIAL 8 MISCEL
TEL INSPECTION RECORD
C �UL O
CONTRACTOR N
ADDRESS SaO4 A� /C�+SG=iF 9
DESCRIPTION OF WORK
NEW k ADD ALTER REPAIR DEMOLISH 1
SO FT NO OF NO OF
SIZE STORIES FAMILIES JV
USE OF STRUCTURE
x 3
GGA/ O
SIGNATURE OF
APPLICANT APPROVALS
ADDRESS DATE INSPE TOR S SIGNATURE
FOUNDATION LOCATION
$ P C $ 9 FORMS MATERIALS
aIc FEE �� FRAME FIRE STOPS
VALUATION Z SO S/10 .I BRACING BOLTS
FEEFURNACE LOCATION
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS GAS VENT DUCTS r
APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH INT
AND STATE LAWS REGULATING BUILD NG CONSTRUC I
TION LATH EXT
SIGNATURE OF HOUSE NUMBER COR
PERMITTEE / RECT AND POSTED S ^ p
r
ADDRESS FINAL 13��
JOHN A LAMBIE COUNTY ENGINEER VALIDATION CLYDE N DIRLAM CHIEF BLDG INSPECTOR
I
CK 0 MO CASH
L, ACO JUL 117 16 25 , � ,' juLl7 1 7 000
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