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DEPARTMENT OF BUILDIN7 f ANQ SAFETY APPLICATION FOR PERMIT
' COUNTY OF LOS ANGELES ' �'� ® E
WM. J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
BUILDING '-
DISTRICT NO. PLAN CK. NO.� PERMIT NO. G`
R
ADDRESS YS> �Jr �y
LOCALITY .,,LJG. �, RECEIVED BY DATE OF APPL. 6/D,�q-TE ISSUED
NEAREST 'IO '✓`` i / EtJ �/
CROSS ST, /✓ y��n�P ` BUILDING
Y`- (/� ADDRESS
OWNER j
MAIL y/ °- LOCALITY /-e!-17h •" i iy
ADDRESS O / 'f NEAREST /
j TEL CROSS ST. K
CITYNO. FIRENO. OF O� TYPE GROUP
ARCHITECT OR TEL. ZONE /�I PLANS
ENGINEER NO. SETBACK LINE /4,eg fRD. NO.
ADDRESS APPROVED
TEL, BY DATE
CONTRACTOR 0. � USE
ADDRESS APPROVED
�� ZONEGP-r BY DATE
HOUSE NUMBERING
LEGALJ n
DESCRIPTION LOT NO. �' � cc_-� A-� MAP NUMBER �O -FIELD CHECK BY
F
TRACT NO. ASSIGNED BY_-Ar- SATE
NO. OF BLDGS. ,.��� CORRECTIONS
SIZE OF LOT �, NOW ON LOT Ma Ale. '
USE OF NO. OF f
EXISTING BLDG, FAMILIES �-/-G Al- 0 /0 / O
DESCRIPTION OF WORK
NEW I Y�& I ALTERATION I I ADDITION
REPAIR I I DEMOLITION
6Q. FT. N�eOF 'n
SIZE RpOMS STORIES Y
EXT. WALLROOF r
COVERING �;� COVERING (�
USE OF 8 RUCTURI,
f APPROVALS'
INSPECTORjS SIGNATURE DATE
t HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FOUNDATION: LOCATION / �G�
PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS f
CORRECT. ./
1 AGREE TOCOMPLY WITH THE CORRECTIONS LISTED FRAME: FIRE STOPS, ✓/
HEREON AND WITH ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS
LAWS REGULATING
,nBUILDING CONSTRUCTION. FURNACE: LOCATION,
SIGNATURE OF GAS VENT, DUCTS
PERM `((YY//ff^^J�"'� ,,
a LATH, INT.
ADDRESS _ ;
�- LATH, EXT.
Q ,..,�.
AUTHORIZED AGT. � % L�- �-✓
PLASTER, INT.
76A 638A OBf3 1080 P. C. $ 9 O
7/2 FEE �a� �--� PLASTER, EXT.
VALUATION ,S- FEE $ ��--®/+FINAL
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