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APPLICATION FOR BUILDING PERMIT 1
DIVISION OF BUILDING AND SAFETY ADBUILDING 5-
DRESS
Department of County Engmeer
County of LOS Angeles LOCALITY `
WM J FOX COUNTY ENGINEER NEAREST �+
CASSATT D GRIFFIN SUP T OF BUILDING CROSS ST
DISTRICT NO RQUP SEWER MAP
FOR APPLICANT TO FILL IN i TYPE hh// BK PG
BUILDING Q / + �- i CONST'v'� -�-
ADDRESSI C/ C7 '� + 1 MAPSTATE
HAY �s
ER
NUMB
LOT NO USE ZONE SPECIAL
CONDITIONS
TRACT
U NO OFBLDGS
7'. r
SIZE OF LOT I NOW ON LOT / BUILDING YARDHWY STREET NAME EXIST
USE OF ^ �-^ SETBACK WIDTH
EXISTING BLDG ��f"T—C" '� FRONT yL�
OWNER O / !`r SIDE +
MAILL ? / �/� P L rl s +
ADDRESS �7 d • U! Al ,0 ' e
a TEL t DWELL 1 UNIT 5 INDUSTRIAL
CITY NO f
2 DUPLEX UNIT— 6 PUBLIC BLDG
ARCHITECT OR TEL i
ENGINEER NO I 3 APT UNITS 7 ADDN ALT ETC
I
ADDRESS 1 r 4 COMMERCIAL 8 MISCEL
14 �p� A� TEL
CONTRACTO;Z24
R� n c nV`� sM� r� !V i'NO, s Y3� - INSPECTION RECORD
--ADDRESS L!/a Y I !Q'LAfVa �SAr "1 l S S1Gh1 aL�-tiO �l"b TFiSc'.4�
DESCRIPTION OF WORE
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L1 O�"� ��� - �i►F�TK'Ay_F�.,1 J Y t�L�C.i"ti-C3 '
NEW ADD ALTER REPAIR DEMOLISH I- P_
SO FT NO OF NO OF
SIZE STORIES FAMILIES 1
USE aSTRUCTURE A C-4 N C (6 I n
o of V2 0 0 ;F 6 1- t-A 6 AS �_ + 4. �1� �� C" ar - Cm►�
SIGNATURE OF pie' S
APPLICANT +� 1! FZROVALSr., ti
ADDRESS DATE INSPECTOR S SIGNATURE
FOUNDATION LOCATION
P C $ FORMS MATERIALS
FEE FRAME FIRE STOPS }
BRACING BOLTS
VALUATION `$
FEE FURNACE LOCATION + r
GAS VENT DUCTS i1
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH INT '(
AND STATE LAWS REGULATING BUILDING CONSTRUC
TION LATH EXT +
r �
,SIGNATURE OF /Q//A/ 9�2 &-,O _ �� HOUSE NUMBER COR
PERMITTEE �' �'\,r/ RECT AND POSTED t
ADDRESS �d�4 /T �"� �/-� I� FINAL
WM J FOX. COUNTY ENGINEER VALIDATION
BY LY�
�~COE632� APR15 1 100
DEPUTY -+ DEPUTY
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BY I 1 BY S ` t f 0
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