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76A638A C68038-64 APPLICATION FOR tJUILDINiERMIT
COUNTY OF LOS ANGELES BUILDING 5
DEPARTMENT OF COUNTY ENGINEER ADDRESS ,
BUILDING AND SAFETY DIVISION LOCALITY C
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST f
COLEMAN W JENKINSSUP T OF BUILDING CROSS ST
DISTRI;aNs] G TYPE � P ESS
FOR APPLICANT TO FILL IN �t7j CONSToe
BUILDING STATISTICAL �LASSI FICA TION §EWER MAP
,ADDRESS CLASS NO _ZDWELL'UNI TS" BK L •PG-
LOT NO BLOCK U(SJE�ZONE MAP (__ `
TRACT ✓`' NO - - -
SPECIAL
NO OF BLDGS �t CONDITIONS '
SIZE OF LOT NOW ON LOT. T
USE OF
I-XtST,NG BLO BLDG SETBACK FROM
L FRONT PROP LINE OF / (STREET)
OWNE i
TYPE OF EXISTING SETBACK HIGHWAY 'I' • YARD = TOTAL
ADDRESS 110 AY WIDTH FROM C L -
CITY
ARCHI CT OR TEL BLDG ETBACK OM
ENGINEER NO SIDE PROP LINE OF (STREET)
TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
ADDRESS HIGHWAY WIDTH FROM C L
TEL + O
d
=
CONTRACTOR NO V
LIC CORNER CUTOFF YES NO GC
ADDRESS NO O
CITY LC"SSICREVERSEREVERSE SIDE FOR SPECIAL APPROVAL w
DESCRIPTI N OF WORKa
NEW AD TER REPAIR •DEMOLISH �� A' .Clrrf �/f c,� ✓
SQ.FTNO OF NO OF
SIZE STORIES Z FAMILIE c
USE OF /J a •�_� � �j�/fj
STRUCTURE CA
SIGNATUFrE OF
APPLICANT _
'P� i1 � Z
� � v `� I� �[ -
VALUATION$ APPROVALS , /•lT4:r DATE (INSPECTOR'S 810 NATURE�f
P C PMT FOUNDATION;LOCATION T`
FEE$ FEE$ � FORMS, MATERIALS "
FRAME, FIRE STOPS,
,- HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE. LOCATION
WITH ALL COUNTY O DINA ES AND STA E LAWS R EATING GAS VENT DUCTS '
9UILDIN CO NSTRU ON CERT TH I DOING ORK / - ��
A.T. HER I L NO PERS yIOLA" LATH INT n
T16 E L R F LIF RELAT"
ING TO WORKM N S'C SATION IN RAN LATH EXT
SIGNATURE OF HOUSE NUMBER COR- _
PERMITTEE RECT AND POSTED
i
ADDRESS FINAL /U
JOHN F LEWIS, PRINCIPAL ST RAL ENGINEER
PLAN CHECK VALIDATION CK • M O -CASH _ PERMIT VALIDATION CK M 0 CASH