HomeMy Public PortalAbout9557BISBY ST_Building (5) 78)
APPLICATION O U ILD G PER
COUNTY.OF LOS ANGELES BUILDING.-AND SAFETY.
FOR APPLICANT TO FILL IN j S
BUILDING
ADDRESS.. l-OCAL TY
CITY !n NEAREST
ZIP CROSS ST.
NO.OF BLDGS. ASSESSOR
SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL
D15-MCTGROUP FIRE BY
TRACT BLOCKLOT NO. C Z
SEl-
OWN ER
LOWNER NO.
STATISTICALT1CM1
ADDRESS
CUSS NKZ��' DWELL UNITS
CITY ZIP !J
ARCHITECT OR T
ENGINEER NO. VALUATION $ ��D
ADDRESS ELDG.-SETBACK ROM
T FRONT PROP.LINE OF IST R EETI
CONTRACTOR TOTAL SET BACp4ROM TYPEOF EXISTING .
LIC HIGHWAY + YARD FRONT PROP LINE HIGHWAY WIDTH
ADDRESS NO. 0
LIC +
CITY CLASS
CONST LENDER BLDG.SETBACK FROM
I
NAME AND BRANCH SDE PRO P.IJN(:OF (STREET)
HIGHWAY + YARD TOTAL SETBACK ROM I TYPE OF EXISTING
ADDRESS QTY SIDE PROP.LINE HIGHWAY WIDTH . Q
V
SQ.FT. NO.OF O.OF CHECK +
Np=
SIZE STORIES FAMILIES ONE -
USE ZEN E MAP Jf
DESCRIPTION OF.WORK - NEW NO. (/
SPECIAL
ADD CONDITIONS
ALTER FINAL BY /
Z✓ REPAIR DATE
Q� l
USE OF DEh1OL
EXISTING BLDG.
APPLICANT TEL
IPRINTI
BY ISIGNATURD >>
I H6"Y AOaKM EDGE THAT I HAVE READ-THIS APPLICATION ATE
THAT THE ADC7VE t$coRtttT AND A,GRfE TO-COMPLY WITH All 9 2 3,7 A
AND LAWS RL-GULATfNG 6ULDIN6 CAf15TR11CTFOf1 I�iT1 FY THAT IN DOING THS
WORK AUTHOpZED HERBY I WILL NOT EMPLOY ANY MRSON IN VIOLATION OF
THE LABOR CODE Of THE STATE Or CALIFOI�IIA IN RELATING TO WORKME?4-S COM.
PENSATION INSURANCE' _ # o • o O o .
SIGNATURE Of t 0 - 2.200
PERMITTEE
ADDRESS 0 0 0 2.2 0 0 6
TES 03,05`80
CITY NO,
P.C- Fee$ Permit Fee >
Issuance Fee
Total Fee C