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74M444iCL #675 9-68 MISCELLANEOUS APPLICAT10if
COUNTY OF LOS ANGELES
:DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION
JOHN A. LAMBIE. COUNTY ENGINEER LOCALITY
COLEMAN W. JENKINS, SUPT. OF BUILDING NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN o_ISTYLti N GROUP TYPE o s
CONST.
a
BUILDING MA PHIHWAY
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ADDRESS 0 C NO- (=; 9 (CIRCLE) STATE MAJOR SECOND LOCAL
LOCALITY USE ZONE SPECIAL CONDITIONS
NEAREST
CROSS S'i. j jja5
LEGAL ;7 REQUIRED EXIST.
rOr 7 SETBACK YARD HWY STREET NAME WIDTH
DESCRIPTION LOT NO. BLOCK
FRONT
NO. OF BLDGP.L,
TRACT S '� NOW ON LOT SIDE
USE OF P.L.
SIZE OF LOT 1-)(Zoo
EXISTING BLDG.
OWNER 'F'" f Cyt•"D e C'I�
MAIL S /o' a.4- 49 v;/ C8ADDRESS 'e /$,7'� - -
CITY �(,!/7j! !G� /J
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APPLICATION FOR _ oT, e �' o
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INSPECOCCUPATION r
ON SAFETY PERMIT f� Lrws� a!I(�L Si�3✓ O
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TRAILER USE it OYti` Ik , lam. t ,� ✓ L
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USE OF STRUCTURES OR DEVICES 1� 27/��� / �9// ��•�I•�-� -
LIMITED TIME USE
DATE DATE
FROM: TO:
APPROVALS DATE INSPECTOR'S
SIGNATURE
OCCUPANCY APPROVAL
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS GROUP OCC. LOAD
APPLICATION AND STATE THAT THE ABOVE IS COR-
RECT AND AGREE TO COMPLY WITH ALL COUNTY TRAILER USE
ORDINANCES AND STATE LAWS REGULATING SUCH
WORK AS INDICATED HEREO
SIGNATURE OF �0 7, SAFETY PERMIT
PERMITTEE l: TEMPORARY
STRUCTURE APPROVED
ADDRESS /5 / TEMPORARY
STRUCTURE REMOVED
FEES FINAL APPROVAL J �
APPLICATION VALIDATION JOHN F. LEWIS, PRINCIPAL STRUCTURAL ENGINEER
(NOT A PERMIT) (ill
M.0. CASH PERMIT VALIDATION CK. M.O; CASH
t i 7 6 5 6i-�-3 N0V17 7 D 10.00-