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78A838A CE 4803 11 57APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A LAMBIE COUNTY ENGINEER NEAREST
CASSATT D GRIFFIN SUP T OF BUILDING CROSS ST
DISTRICT NO !I!�ICONST
TYPE SEW MAPFOR APPLICANT TO FILL IN_
BUILDNG
fADDREISS � , hif s T; STATISTICAL CLASSIFICATION
CLASS NO it DWET NO �J Q BLOCK NUMAPMBER /'O� HWYE YES O
TRACT /�+ �/ USE ZONE SPECIAL
NO OF BLDGS � CONDITIONS
SIZE OF LOT 3Ap 10v �0f� NOW ON LOT
USE OF
EXISTING BLDG UILDING EXIST
B SETBACK YARD HWY TREET NAME WIDTH
OWNER ,(J/ FRONT
MAIL P L
ADDRES Aq Wdl SIDE
TEL P L
CITY No INSPECTION RECORD
ARCHIT CT OR TEL
ENGINEER NO
ADDRESS
TEL /
CONTRACTO i NO OJ
ADDRESS
DESCRIPTION OF WORK
NEW ADD ALTER REPAIR DEMOLISH
SQ FT Jf 0 NO OF / NO OF
SIZE STORIES / FAMILIES
USE OF STRlJdTURE ✓�
i39 3
SIGNATURE OF APPROVALS
APPLICAN�9T '
�� DATE INS ECTOR_S SIGIt-{A_TUR'E
ADDRESS nG
FOUNDATION
STMATERIIALS ION /�
P C S-A I—jqef2—
FRAMEFIRE STOPS
FEE BRACING BOLTS
VALUATION 12 p
FEE FGAS VENT URNACE DUCTS LOCATION 1:?-j 9� /
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP LATH INT
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND Q
AGREE TO COMPLY WITH ALL COUN Y ORDINANCES AND
STATE LAWS RE LATIN. BUIL N61 CONSTRUCTION LATH EXT 7
SIGNATURE OFHOUSE NUMBER COR Q
PERMITTEERECT AND POSTED Q hJ
ADDRESS FINAL GG�IV�r1�//P�1d�
CLYDE N DIRLAM P INCIPAL STRUCTURAL ENGINEER
PLAN CHECK VALIDATION 1c M o CASH PERMIT VALIDATION c1c It o CASH
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