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APPLICATION FOR BUILDI G PERM
COUNTY OF LOS ANGELES DUI LbINa
DEPAIlTMENT OF-COVNTY ENGINEER ADDResa
BUILDING AND SAFETY DIVISION LOC A LI T Y
JOHN A. LAMBIE. COUNTY F-NOINEER "AREST
COLA AN W. JENKINSAUP'T OF GUILDING CROSS IT.
DIST O. RO TY0K.
FOR APPLICANT TO FILL IN coNpr.
aUILDINa �yr� STATINTICAL�CCLL/A��SSIFICATION SE ER FIAT
ADORE" '150 P CLASS NO'. 1e9 UNITS-, BK FO
LOT NO. 'LOCK off ZONE MAP
NQ
TRACT SPECIAL
RO. DF BLDG$. CONDI TION3
-
SIZE 00 LOT MOW OM LOT
USE OF
BLDG. *ETSACE FROM
TEL. FRONT PROF. LIRE OF (STREET)
O TETE OF EXISTING SETBACK HIGHWAY YARD = TOTAL
CIL
ADDRHSS
CITY BLDG. SRTSACK FROM
RCHITEC TEL. SIDE PROF. LINE OF STREET
11INHHR NO.
TYPE.OF EX IJTIRG SETEACR H•ISHWAY.�-�} '-.YJ.Rb =. TOTAL
AODREIS HIGHWAY WI TH FROM C.L. '
•CONTRACTO AoL y 13
ADDRHSf I S LL NO d CORNER CUTOFF YElt NO 8
CITY LC4 A,ICC LIC C —Z SEE REVERSE SIDE FOR SPECIAL APPROVALS
ESCRIP ION OF WORK
NEW ADD ALTER REP-AIM DEMOLI
-a FT. NO. OF O. OF
SIZE STORIKS FAMILIES
USE OF
STRUCTURE O O
1
SIONA71URE OF '
APPLICANT
VALUATIbN s j I k ,00
APPROVALS .bATR IMWICTOR'S SIGNATURE
P.C. - PMT. FOUNDATION, LOCATION
FEES FHH S F FORME ATERIALI
RA E, FIRE ITOP2'.
I H'K?":GY ACKNOWLEDG■ THAT 1 HAVE READ THIS APPLICATION EQACINO
AND STATr THAT THE ABOVE IS CORRECT AND AGRIM TO COMPLY FURNACES LOCATION
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING OIAS U
{UILDI NO CONSTRUCTION. I CERTIFY THAT. IN DOING THE WORK _
ALI HQRIZm HERESY I WILL NbT EMPLOY ANY PERSON IN VIOLA-. LITH. INT.
TQM OF THE LABOR,COD[ OF THE STATE OF CALIFOf NIA"RELAT.
ING TO WORKMEN'S COMPENGATION INIu LATH. [%T.
UIGNATURE OF HOUSE NUMSIKR COR-
' PERMITTEE RKCT
ADDRESS A L
JOHN F_ LEWIS.'PRIN IrAL S'roRAL FNGINEI!R
PLAN CHEM VALIDA71ON cx. M.o. usH _ PE9 IIT VAIMATION ucM.o c"'II