HomeMy Public PortalAbout9557BISBY ST_Building (2) APPLICATION FOR BUILDING PERMIT
FOR APP)_ICANT TO FILL IN (Print or type only)
COUNTY OF LOS ANGELES
nDDs DIN DEPARTMENT OF COUNTY ENGINEER
CITY ZIP BUILDING AND SAFETY DIVISION
NO.OF B BUILDING �J
SIZE OF LOT Q NOW ON LOT ADDRESS /
TRACT BLOCK LOT LOCALITY
TEL NEAREST
OWN ER ` NO Coss ST.
�i [�
ASSESSOR
Tr
ADDRESS MAP BOOK PAGE PARCa
CTY LP 91 n DISTRICT GROUP TYPE FIRE
ARC-IIT OR TEL O CONST ZON !�
ENGINEER NO. STATISTICALCASSIR T SEWER MAP
ADDRESS
TEL NO.CLASS _DWEIL UNITS L BKT_:�G
CONTRACTOR NO. OE ZONE I MAP
UC NO.'
ADDRESS NO. SPECIAL
LIC CONDfTI M
CITY C.ASS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑
coNsFRLKTVON LENDER
NAME AND BRANCH LDG. CSC FROM
F PROP.UNEOF (STREM
ADDRESS C17Y ' TOTAL SETBACJC FROM TYPE OF DUSTING
SQ.FT: //,w. NO.OF NO.OF CHECC H Y + YARD FRONT PROP LINE, HIGHWAY WIDTH
SIZE STORIES FAMIUES ONE
DESCRIPTION OF WORK NEW ❑ + O
ADD SIDE PROP.UNE Of. (STREET) Y�
ALTS ❑ TOT)kTYPE OF EXIST ING
HK;KWAY + YARD SIDE PROP.UNE AY WIDTH
USE OF REPAIR El
EXISTING BLDG. DEMOL ❑ + _
APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑
1 P RI NTI NO.
IN OPEN SPACE YES ❑ NO ❑
BY(SIGNATURE) IN COASTAL PERMIT ZONE YES ❑ NO ❑
VALUATION$ ZZ 000 1 1.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLIG.T}ON AND STAR
THAT THE A90VE IS CORRECT AND AGREE TO COMPLY WTTH All ORDI.NANCPS �� O
AND LAWS R73G T1 NG BU UDNG CONSTRUION.CTI CERT1 FY THAT IN DOING THE LY7
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN V)OLATKON OF
TIS LADOR ODOE OF THE STATE OF CAW FORMA W RELATING TO WORKMEN'S COM-
PENSATKIN INSURANCE -
G �
SIGNATURE OF �J� y7�() ��!
ADDRESS
TEL DATE l _ I f BY •_
aTY NO.
I
MAKE CHECKS HECi{S PAYABLE TO: � $ FEE $
HARVEY T.BRANDT,COUNTY ENGINEER j
PLAN CHECK VAUDATION CTC Y.O. CATH PERMIT VALIDATION cic M.O. CAJH
1�5 9-JAN 16 1 D g 2,5C) A`�
m> 76A63BA CE real 3-75 I +