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76ACDEA CIS, 0803 "'APPLICATION FOR BUILDIN PERMI
COUNTY OF LOS ANGELES ASSESSOR
DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCE
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMNIE, COUNTY ENOINEKR ADDRESS
COLKMAN W. JENKINS, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO L IN NEAREST
(Print r type only) CROSS ST. �
DISTRICT N G P TYPE P BY
BUILDING i CONST.
ADDRESS
STATISTICAL LASSIFICATI N SEWER MAP'
LOT NO. BLOCK I — ,
I CLASS NO DWELL,UNITS� -BK
TRACT V
ONE MA
NO.OF BLOGS. NO.
SIZE OF LOT NOW ON LOT SPECIAL
USE OF /A� ON DI TIONS
EXISTING BLDG, C7
TEL-
OWNER
LOWNER .` NO BLDG.SETBACK FROM
ADDRESS / FRONT PROP.LINE OF (STREET)
f► TYPE OF EXIST1SETBACK .HI OHWAY + YARD = TOTAL
CITY y HIGHWAYWID FROM C.L.
ARCHIT CT OR TEL. + _
ENGINEER NO. BLDG.SETBACK FROM
ADDRESS SIDE PROP.'LINE OF (STREET)
TEL. TYPE OF ISTING SETBACK HIGHWAY + = OTAL
CONTRA CTO NO. r HIGHWAY WIDTH FROM C.L
ADDRESS LO + p.
LIC. CS
CITY G CLASS CORNER CUTOFF YES ❑ NO ❑ oC
CONSTRUCTION LENDER
NAME AND BRANCH r SEE REVERSE SIDE FOR SPECIAL APPROVALS
ADDRESS
SQ, FT. NO. OF NO. OF NEW ❑
EF
��Q STORIES FAMILIES
USE OF P ADD ❑
STRUCTURE ALTER ❑
REPAIR❑
SIGNATURE OF
APPI-r ANT DEMOL
VALUATION f
APPROVALS - DATA IHBF[cTon•G GUNATun[
�J FOUNDATION. LOCATION
FEE f FEE f / / a FORMS MATERIALS
FRAME: FIRE STOPS,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS
AND CTAT[ THAT THE ABOVE IS CORRECT AND AGR[[ TO COMPLY FUR ACE: LOCATION,
WITH ALL OR"'KANC[! ND LAWS REGULATING BUILDING COM- GAS VENT, DUCTS
STRUCTION. I CERTIFY HAT IN DOING THE WORK AUTHORIZED
H[R[BY I WIL4 NOT Q ANY FIR10 VI TION OF THE LATH, INT.
LABOR CODE OF THE T[ 10 {AL MI RELATING TO
WORKMEN'! COMFEN AINBURAM LATH, EXT,
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED
ADDRESS FINAL
JOHN F.�LOVIS.. PF III CIP T L+�� .RAL ENGINEER
PLAN CF= VALIDATION CK. M.O. CASH _ q rL.ill�ill VAUDATION Cc N.O. CASH
� 1' 0 1 0 4 my 5 1 D 1 72-5-
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