HomeMy Public PortalAbout9671 BROADWAY_Certificate of Occupancy__ TEKPt J Y.
-APPLICATION FOR OCCUPANCY° INSPECTION':
FOR APPi_.T -ANT TO FILL IN (P"infcr type only) e' : COUNTY OF LOS ANGELES
f� + ,DEPARTMENT OF COUNTY ENGINEER
BUILDING G��D C , �, p . , . BUIL''DING'AND SAFETY DIVISION
ADDRESS C t5L
BUILDING
.CITY -t ADDRESS"�_!T_67/
, -
0. OF1 LOCALITY
SIZE OFLOT ., LOT � NOW ON LOT - '
- - NEAREST
TRACT - BLOCK L'OT NO. CROSS STr' y,f
i ASSESSOR
OWNER .� NO. 2�ss ` DAISTROICT TYPE PF
IRE- PROCESSED BYARCEL
ADDRESS 1 0 CONST. ZONE.
�T II, ..
CITY ' 1-Q; ZIP 1�_ USE ZONE MAP
SIZE,OF - NO. OF,
EXISTING BLDG.' STORIES SPECIAL -
_ . CONDITIONS
. PRESENT USE OF BUILDING _ BLDG. SETBACK FROM
FRONT PROP: LINE OF (STREET)
HIGHWAY. -} YARD . TOTAL SETBACK FROM TYPE OF E%ISTIN
N0. PARKING -
FRONT PROP. LINE HIGHWAY WIDTH
SPACES PROVIDED �,. } _ (�
BLDG. SETBACK FROM
REASON FOR INSPECTION REQUEST ` :SIDE PROP. LINE OF- - (STREET) F
HIGHWAY- TOTAL SETBACK FROM TYPE OF XISTIN V
= W
} YARD SIDE PROP. LINE HIGHWAY, WIDTH d
L.� 1 1 - 41141
z
CORNER CUTOFF YES NO
'N1 GOnFV PROPOSED MAX. DEC. - Z OCCUPANCY GROUP _
4_ 7Q. c_^j� AS VERT FIED-. OCCUPANT
THEREBY AC KNOW LEDGE THAT I HAVE READ,THIS LOAD
APPLICATION.AND STATE THAT THE ABOVE ISCOR-
R ECT. EXIT HARDWARE
-
NO SPEC. KNOWL. ❑
NO. OF'EXITS. ,=
' PANIC DEVICES ❑
SIGNATURE OF
* POICANT, -
PARKING -
ADDRES/S' - . ,` (-y1n SPACES -REO'D n p PROVIDED �
. - ZIP �") 0
PHON'Qc6"k 'Al
MAKE' CHECKS P,A;XA'HLE TO:-
HARVEY T. BRANDY COUNTY ENGINEER FINAL;
TE BY /
DA
2 :
APPLICATION VALIDATION cj M.o. cnsH
76A662-CE992 I2-73 .1 1-,2Pn& 14 2'2 :D,. _ 3 \J.O.O !✓8 -