HomeMy Public PortalAbout9575BISBY ST_Building ,-APLICATION FOR COUNTY OF LOS ANGELES
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DEPARTMENT OF COUNTY ENGINEER
3 I L D I N G PERMIT BUILDING AND SAFETY D ISION
FOR APPLIG4N.T BUdDING TO FILL IN ADDRESS s
BUILDING r LOCALITY
ADORES .7 �'
NEAREST
QTY _ ZIP Q CIZISSST. irk t2
NO.O F R
SIZE OF LOT O NOW ON LOT MAP BOOK PAGE PARCEL
TRACT /0.9 92 BLOCK LOT DISTZCT GROUP TYPE FIRE
WNO. � �� O« � �E BY
IM
ONER NO. V
ST ATISTICALCAS5IFlCATION - S &W?
ADDRESS CLASS NO. DWELL UNITS �hG
CITY C ZIP USE ZONE
ARCHITECT OR
ENCiI N EEP NO. CON DFTK)NS
ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑
CONTRACTOR NO. X6-1 W BLDG.SETBACK FROM
IC_ pp FRONT•PROP.UNEOF (STREET)
ADDRESS �� G( LNO. KTOTAL SETBACK FROM TYPE OF EXISTING
LIC HIGI fWAY + YARD• - FRONT PROP.LINE HIGHWAY WIDTH
mY . CLASS e
03NSTRUCT) ENDER ' + -
AND BRANCH BLDG.SETBACK FROM. O
ADDRESS QTY SIDE .UNC OF (STREET) 00
SQ.FT. -NO:OF NO.OF CHECK HIGAAY + YARD - T SETBACK FROM TYPE OF EXISTING r
SIZE -ST ES FAMILIES ONE DE PROP.UNE - HIGHWAY WIDTH . a
—� +. .- — Z
DESCRIM ON 6F WORK'' NEW ' —
ADD CORNER CUT - ?ES IT1. NO ❑
CLA ALTER IN SPACE YES L❑l NO [IRfPA I R
USE OF IN • AL PERMIT LONE Y5 ❑ NO ❑
EXISTING BLDG. DEMOL.
APPLICANT TEL i
IPRINT) . NO.
BY LSIGNATURD
I FII3tEBY AOOrOWLEDGE THAT I HAVE-MAD THA APPUCATK)6 AND STATE. .
THAT THS ADOVE IS CORRECT AND AGREE TO COMPLY WITH ALL-O�QI THE _
AND LAWS REGIAATtNG BULDING COMSTRLICTKJN.I C$T1FY THAT IN DOING THE
WOR%
LAH�R IIOf1IED HEREBY I WILL NOT EMPLOY ANY PEKXKO
PERSON IN VATN OF
THE CODE OF THE STATE OF CAU FORK A IN RELA TWG TO WORKMEN'S COW
PENSATION LNSU RA?ice .
I
SIGNATURE OF FINAL �J_+� BY//Je�� (-
PERMITTEE DATE/ e��CJ• '-
ADDRE$§
C17Y
NTELO.
^l4iGS P.C. Fee$ Permit Fee
risou 1Ce Fee
VALUATION$ O O Total Fee
;PLAN CHECK VALIDATION cx wo. C-"H i; PERMIT VALIDATION cx M.0. C&mH
83 .1RJLL'20 1 D a ao o dye
4% 7EAGWA u W 4A em _