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ADBS•9
176A1.5: APPLICATION FOR BUILDING PERMIT ],
II 55 DIVISION OF BUILDING AND SAFETY
BUILDING
ADDRESS
Department of County Engineer
County of LOS Angeles LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
CASSATT D.GRIFFIN, SUPT OF BUILDING CROSS ST.
FOR APPLICANT TO FILL IN DISTRI O. GROUP PE BK PG
SEWER MAP
ry/
CONST�+�'
BUILDING �iC(j c T- Q,s MAP �1 STATE
ADDRESS LLJJ ] ✓/ NUMBER v HWY YES NO
LOT NO. I ii- BLOCK USE ZONE SPECIAL
Q— / CONDITIONS
TRACT y J " I
® �J NO. OF BLDGS.
SIZE OF LOT �O ;C 7 / NOW ON LOT BUILDING SE BACK YARD HW STREET NAME WIDTH
USE OF
EXISTING BLDG. ' FRONT f �}
P. L. t (J_
OWNER SIDE
P. L.
MAIL
ADDRESS q L. / O TRACT DWELL. I UNIT 5 INDUSTRIAL
CIT` NE /j�J'_>'#wj I DWELL. f I UNIT 6 PUBLIC BLDG.
ARCHITECT OR TEL. 2 DUPLEX2 UNITS
ENGINEER NO. 3 APT. UNITS y ADDN.,ALT., ETC.
8 MISCEL.
ADDRESS 4 COMMERCIAL
TEL M 'b' INSPECTION RECORD
TRACTO Np��
i
ADDRESS
DESCRIPTION OF WORK
NEW ADD ALTER REPAIR DEMOLISH
SO. FTQ 5+ NO. OF NO. OF 1
SIZE Q n STORIES / FAMILIES I
USE OF STRUCTURE
SIGNATURE OF
APPLICANT //�� APPROVALS
ADDRESSI'!��////A DATE INSPECTOR'S SIGNATURE
FOUNDATION: LOCATION _
$�/`� /1 ^• �^ P. C. $/� �` �" FORMS. MATERIALS
C K U U FEE FRAME: FIRE STOPS. p�
VALUATION $�� CC) BRACING. BOLTS --
FEE rte( FURNACE: LOCATION. r,
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS GAS VENT. DUCTS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT �,.
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH, INT. ! `1 -
AND STATE LAWS REGULATING BUILDING CONSTRUC-
TION. LATH. EXT.
SIGNATURE FOL HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED
/� - - _
ADDRESS ."'1/ FINAL `
JOHN A.LAMBIE. COUNTY ENGINEER VALIDATION CLYDE N. DIRLAM. CHIEF BLDG. INSPECTOR
CK MO CASH
5574U FEB 26 1. 6 11 .001p
5 6 7 2 5 FEB 2 9 1 2 2.n O n
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