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7GA638A CE#803 1088 APPLICATION FOR BUILDING PE�FlMIT
BUILDING AND SAFETY DIVISION BUILDING
Department of County Engmeer ADDRESS J L
County of Los Angeles LOCALITY
JOHN A LAMBIE COUNTY ENGINEER NEAREST 10,
CASSATT D GRIFFIN SUP T OF BUILDING CROSS ST
DISTRICT NUj GROUP TYPE SEWER MAP
FOR APPLICANT TO FILL IN BK PG
CONST
BUILDING f .72- /1)
ADDRES T) �V STATISTICAL CLASSIFICATION
LOT NO "� BLOCK CLASS NO DWELL UNITS
MAP STATEHWY YES O
/ NUMBER (J
TRACT [Q USEZONE SPECIAL
NO OF BLDGS CONDITIONS
SIZE OF LOTNOW ON LOT
USE OF
EXISTING BLDG BUILDINGEXIST
SETBACK YARD HWY STREET NAME - WIDTH
OWNER 1 FRONT
MAIL Q /}�, ► " /� P L
A0DRESS�SQ n-V�KJ-t�bQ--'Otho W✓-C- SIDE
CITY � I�ll� IrWVi L� P L
NO
INSPECTION RECORD
ARCHITECT OR ®� -TEL
ENGINEER NO
ADDRESS
TEL 7~L -7 rp NJ,�/,P,&pnY - /J/I
zlY
CONTRACTOR NO
P4 CFiLL F7�rai/✓
ADDRESS
3
D CRIPTION OF WORK
NEW ADD AL-ER REPAIR DEMOLISH
SQ FT NO OF NO OF
SIZE STORIES FAMILIES
USE OF STRUCTURE 1
i
r APPROVALS ^
SIGNATURE OF
APPLICANT ATUr I TOR S SI TURE
ADDRESS - FOUNDATION LOCATION D'
FORMS MATERIALS �[/L
P C g FRAME FIRE STOPS 1�7
BRACING BOLTS II J ( (\ dam
VALUATION-$ � �O �a FEE $ ,—+ FURNACE LOCATION �
FEE Z GAS VENT DUCTS
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP LATH INT
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND LATH EXT '� lT\\PA
STATE LAWS REG LATING BUILjipING 666 C NSTRUC ION
SIGNATURE OF� I HOUSE NUMBER COR
PERMITTEE Cl��✓1 RECT AND POSTED
ADDRESS FINAL
JOHN A LAMBIE COUNTY ENGINEER CLYDE N DIRLAM PRINCIPAL STRU URAL ENGINEER
PLAN CHECK VALIDATION CK m o CASH PERMIT VALIDATION CK m O cas
LU00693u JUL 26 1 230