HomeMy Public PortalAbout4846 AGNES AVE_Building_7/24/1975_ADD FAMILY RM AND BATHROOM APPLICATION FOR BUILDING PERMIT
FOR XPPLICANT TO FILL IN—(P , r o rra o Iv)
BUILDING
/ COUNTY OF LOS ANGELES
ADDRESS ,E� DEPARTMENT OF COUNTY ENGINEER
c I T z I P i^BUILDING AND SAFETY DIVISION
NO OF BLDGS BUILDING /?
SIZE OF LOT13,6-:'NOW ON LOT �"� ADDRESS
p d
TRACT Q B CK LO LOCALITY
TEL NEAREST
OWNER NO CROSS ST
/� ASSESSOR F K
ADD SS (ii rte' MAP BOOK PAGE PARCEL_* t-
e DISTRICT GROUP TYPE FIRE PR ESfED BY
CITY a ZIP 7� CONST
r� Z ry 4
ARCHITECT OW
TEL 'lag
ENGINEER NO
STATISTICAL CLASSIFICATION SEWERM�.P
ADDRESS 4 CLASS NO�DWELL UNITS I.
PG
CONTRACTOR o r NOL22-S30.) USE ZONEMAP
NO
ADDRESS 0 'Xi NO L 1C z2.J SV p SPECIAL
LIC ff�� CONDITIONS
CITY
CONSTRUCTION LENDER CLASS
ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑
NAME AND BRANCH BLDG SETBACK FROM
FRONTPROP LINEOF (STREET)
ADDRESS CITY HIGHWAY `+ YARD = NOTAL SETBACK FROM TYPE OF EXISTING
SQ FT NO OF NO OF CHECK FRONT PROP LINE HIGHWAY WIDTH
SIZE I STORIES FAMILIES ONE
+ _ d
DESCRIPTION OF WOR 0� NEW ❑ "� � �
ADD BLDG SETBACK FROM
4.— SIDE PROP LINE OF (STREET)
LTER ❑ HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING C
CD
EPAIR❑ SIDE PROP LINE HIGHWAY WIDTH Cl-
,,
_ ! w
EX SOT NG BLDG EMOL ❑ + r•
APPLICAN STEL S,.2' .� CORNER CUTOFF YES ❑ NO ❑ _
(PRINT) �e�'(ed,� NO
1 +
IN OPEN SPACE YES,[] NO ❑„� �,
BY (SIGNATURE)
IN COASTAL PERMIT ZONE S YES ❑ NO ❑
J
VALUATION
dr
I HEREBY ACKNOWLEDGE THAT I HAVE REA T IS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY C AAA
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON " A
STRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED
HEREBY I WILL NOT EMPLOYVANY PERSON IN VIOLATION OF THE
LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO
WORKMEN S COMPENSATION INSURANCE
ti T v
9.
SIGNATURE
PERMITTEE OF 4 d y
ADDRESS
TEL FINAL BY
CITY NO DATE y� Q 7 L
HAKE CHECKS PAIABLL 10 FEE J v FEE $ (� �
HARVEY T BRANDT COUNTY GINEER] qt5F-� I
PLAN CHECK VALIDATION CK M 0 C SH PERMIT VALIDATION Cy mo c sH
6 4 3 JUL L24 2 3 U -� 4 9.5 O oyo 64 5 ,jUL 24 ib 8 2.5 0 ,&w
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78A838A CE#808_5174
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