HomeMy Public PortalAbout9173 FORTSON DR_Building__ -APPLICATION FOR BUILDING PERMIT
r. ICANT TO FILL IN (Print or type only) : I
BUILo'
NG COUNTY OF LOS ANGELES
ADDRESS C Z T D P:%v F- - DEPARTMENT OF COUNTY ENGINEER
CITY L,MLC `iT ZIP Q/7 y O BUILDING AND SAFETY DIVISION
NO.OF BLDGS BUILDING
SIZE OF LOT <x, I i.o., NOW ON LOT Z ADDRESS17
TRACT/4,13Y4 BLOCK; LOT NO 3 .2. LOCALIT
LFS M/i"ToN AND 06'TTy TEL NEAREST _
OWN R C('.L 10.! NO CROSS ST
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ASSESSOR _
ADDRESS l'73 I-C1YL[,SOn1 D/�IVC- MAP BOOK PAGE PARCEL
DISTRICT I GROUP TYPE FIRE OCIISED BY
CITY 146M LE OT 'Clk-IP ZIp 9/Zko �D-v CONS ZON _
ARCHITECT OR - TEL.
ENGINEER ( NO.
STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS- IFCLASS NO�-DWELL UNITS B G
CONTRACTORC� R PEARSC�1 NOL2�6-.a USE ZONE
NADP
ADDRESS _ LIC. SPECIAL
LIG. RR CONDITIONS
CITYS " Rie L- ? , LASS
rJ 1 ROAD PARTMENT APPROVAL REQUIRED YES ❑ NO❑
CONSTRUCTION LENDER
NAME AND BRANCH BLD SETBACK FROM p}.
FRO T PROP.LINE OF (STREET)
ADDRESS CITY _ TOTAL SETBACK FROM TYPE OF EXISTING
Y - �
SQ. FT/,p NO. OF � NO. OF � CHECK HIGH } YARD FRONT PROP LINE HIGHWAY WIDTH C
,SIZE 70 2- ISTORIES FAMILIES ONE
DESCRIPTION OF WORK DD- r3EbAootij NEW' CA❑
BLDG.SETBACK FROM - Z
H[l'!. REM obEL.. ViTC-MLL-v ADD SIDE PROP. LINE OF TREET)
ALTER ® _ TOTAL SETBA K FROM TYPE OF (STING
HIGHWAY } YARD - SIDE PROP LINE HIGHWAY DTH
REPAIR❑
USE OF }
EXISTING BLDG.RIF
-C L=I/ CG DEMOL ❑
AiPPLICAN7 yL€S Al /4CIC4A# J TEL p ``' CORNER CUTOFF YES E] NO
f�Z37S ❑
(PRINT) NO.20
BY (SIGNATU E) C IN OPEN SPACE YES ❑ NO ❑
Q, IN COASTAL ZONE YES ❑ NO ❑
VALUATIONY- 270 CATEGORICAL EXEMPTION YES❑ NO ❑
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE)
WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON-
STRUCTION I CERTIFY THAT-IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE)
HEREBY I WILL T EMPLOY ANY PERS N IN VIOLATION OF THE
LABOR COOE HE STATE CAL RNIA IN RELATING TO
WORKMEN'S C MPE SATIONI UR NCE
SIGNATURE �r
PERMITTEE
ADDRESS �-
�,, FINAL' BY
BY /
CITY NOL DATE / 16 7�
MAKE_ CHECKS PAYABLE TO: P. E 6 FEE'' �✓
HARVEY T. BRANDT._COUNTY. ENGINEER FEE FEE
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PLAN CHECK VALIDATION CK M O CASH _ PERMIT VALIDATION CK M 0 CASH
76A638A CEN803 7/73 •V•'4''4,f'q-NAR. 13• 1