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DEPARTMENT UI COUNTY IIQGINEEH BUILDING
;DIVISION OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER APPLICATION
CASSATT D. GRIFFIN, SUPT OF BUILDING
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
DISTRICT NO. I PLAN CK.OR REC. No. PERMIT NO.
BUILDNG
ADD EISS d z
LOCALITY RIECEIVEDPY DATE OF APPL. DATE ISSUED
NEARESTt 7
CROSS ST
BUILDING
OWNER a ADDRESS .j
MAIL O Y/ I - LOCALITY 77-
G
ADDRESS /
TEL. NEAREST
1.
CITY O �p,�-SSG`. CROSS ST. rQ Q cam.iQ
ARCHITECT OR TEL, FIRE NO. OF TYPE GROUP
ENGINEER - -- NC. ZONE I PLANS __T_
BLDG. ORD. NO.
ADDRESS r SETBACK LINE
CONTRACTOR p-J o 8 I S 6 _ USE APPROVED
!. ZONE.- BY DATE
ADDRESS (('' � D�/ t HOUSE NUMBERING
LEGAL MAP NUMBER NO. ASSIGNED BY
DESCRIPTION LOT NQ. BLOCK
yy,� r CORRECTIONS
TRACT !I O- �® r^ �A ^I n?1 �. r l / .'
NO. OF
SIZE OF LOT 9� I NOW ON LOTS
USEOF LI
EXISTING BLDG. '�'1-F"1 e'�-�' FAMILIES
DESCRIPTION OF WORK o -
NEW ALTERATION ADDITION D
Z
REPAIR DEMOLITION Y
r
SIZE T --' ROOMS STORIES _
EXT. WALL D , ROOF
COVERING I COVERING
USE OF TRUCTURE
INSPECTOR'SIN �. S APPROVALS
DATE
FOUNDATION: LOCATION
FORMS, MATERIALS /
I HEREBY ACKNOWLEDGE THAT I HAVE READ TH15 AP- FRAME: FIRE STOPS.
PLICATION AND STATE THAT THE INFORMATION GIVEN 15 BRACING, BOLTS
CORRECT.
IAGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE: LOCATION, t
AND STATE LAWS REGULATING BUILDING CONSTRUCTION. GAS VENT, DUCTS
425
` _ ^
SIGNATURE OF LATH, INT.�G ,�(�
PERMITTE c-
0 /� r LATH. EXT. -- { j"
ADDRESS_ Cwt..
PLASTER, INT.
AUTHORIZED AGT.
PLASTER, EXT.
$ FEE S HOUSE NUMBER COR-
RECT AND POSTED
VALUATION FEE $4 ^^ FINAL
76A638A DBS 3 B-SY