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APPLICATION LOCALITY / ` I ,
NEAREST
DIVISION OF BUILDING AND SAFETY
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Department of County Engineer DISTR!PT NO RECEIPT NO PERMIT NO.
County of Los Angeles 7 V-)46 9
WM J FOX, COUNTY ENGINEER GROUP DATE RECEIVED DATE ISSUED
CASSATT D GRIFFIN, SUPT OF BUILDING
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FOR APPLICANT TO FILL IN
TYPE NST RECEIVED BY ISSUED BY
OWNER MAP �G. OO STATE
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SETBACK WIDTH
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CONTRACTOR � tfr- NO I
SIDE
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ADDRESS
� DATE CORRECTIONS INSPECTOR
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LOT NO ./fl* BLOCK pS7
TRACT [�J .57-6 NO OF BLD
91ZE OF LOT ® � I NOW ON LOTS /
USE OF "'-
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DESCRIPTION OFWWORK
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SO FT. NO OF NO OF �� G� r '�' r
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EMPLOYEES T3T �t,a Gem p 6 �/ �✓�/
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP-
PLICATION AND STATE THAT THE INFORMATION GIVEN ISS APPROVALS INSPECTOR'B SIGNATURE "TE
CORRECT �/n'q2
I AGREE TO COMPLY WITH ALL COUNTY ORDINANCESI FOUNDATION LOCATION r/`XJ-FYi I/►1 -2
AND STATE LAWS REGULATING BUILDING CONSTRUCTION FORMS,MATERIALS
FRAME FIRE STOPS,
SIGNATURE OF /P� BRACING,BOLTS �v
PERMITTEE_ �Ka' a� FURNACE LOCATION,
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LATH, INT
AUTHORIZED AOT ®/
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$ P C $ HOUSE NUMBER COR-
FEE RECT AND PORTED "
VALUATION' FINAL
FEE
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