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7GA638A CE#8031038 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING /.-17
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 GROUP TY rl PR SED BY
FOR APPLICANT TO FILL IN - c ST
BUILDING STAT TICAL CLASSIFICATION_ I SE ER MAP BK
-
ADDRESS _ CLASS NO WELL UNITS `
MAP STATE
LOT NO BLOCK NUMBER- HWY YES NO r
TRACT USEZONE SPECIAL
NO OBLDGS / CONDITIONS - <
SIZE OF LOT I NOW OF N LOT � `
USE OF
EXISTING BLDG r SETBBUILDING ACK YARD HWY STREET NAM WIDTH
IST
OWNER FRONT e E
MAIL �q P L ^>
ADDRESS SIDE y
TEL P L
CITY NO _ INSPECTION RECORD
ARCiqlTgeV OR - TEL l p
ENGINE&R NO 16.
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ADDRESS
TEL
CONTRACTOR NO S
ADDRESS - y
DESCRIPTION OF W&K1 '
- r
NEW ; ADD ALTER REPAIR DEMOLISH
SQ FT NO OF NO OF
SIZE STORIES FAMILIES
USE OF
STRUCTURE
I -
SIGNATURE O
APPLICANT APPROVALS DATE INSPECTOR S SIGNATURE
ADDRESS FOUNDATION LOCATION
O S FORMS MATERIALS'
VALUATION FRAME FIRESTOPS
BRACING BOLTS
PC PMT ..qq FURNACE LOCATION /
FEE $ FEE $Li a.► GAS VENT DUCTS F 7;--,7 7— w+�
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP-
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND LATH INT
AGREE TO COMPLY LITH ALL COUNTY O DINANCES AND
STATE LAWS REG A ING BU DI ODOVTRUCTION LATH EXT
SIGNATURE HOUSE NUMBER COR-
PERMITTE RECT AND POSTED
ADDRESS 1'INAL ®.A-;- 7 I
CLYDE N DIRLAM PRINCIPAL STR KOCTURAL E cases R
HE
PLAN CCK VALIDATION CK nl o cases PERM VALIDATION
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A 3 1 0 3U NOV25 1 A - 200 ®'
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