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75M.444-CE 9575 "e MISCELLANEOUS APPLICATION
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER A°,o o E S;T r
BUILDING AND SAFETY DIVISION
JOHN A. LANirBIE, COUNTY ENGINEER LOCALITY
COLEMAN W. JINKINi SUPT. OF IUILDINO NEAREST
Cid
FOR APPLICANT TO FILL IN orSTn T No angylf TYKE
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ADDREN1 T�� /7 GOIUT C NAP HIHiWAY
XO. (CIRCL[ STATE MAJOR SECOND LOCAL
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USE ONE SPECIAL CONDITIONS
LOCALITY pV+ 02NEAREST
CR099 3T. {—Q
LEGAL REQUIRED YARD HWY STREH NAME EXIST.
DESCRIPTION LO NO. BLOCK SETBACK rIDTH
FRONT
NO. OF BLDG S. P.L.
TRACT NOW ON LOT SIDE
USE OF BLD 91
SIZE OF LOT EXIS INd
OWNER C
MAIL
ADDRESS ;L-n m
TEL.
CITY NO.
APPLICATION FOR
OCOUPANCY
INSPECTION x SAFETY PERMIT O
TRAILER USE [L.
USE OF STRUCTURES OR DEVICESbn6---a o62 7772-s _
LIMITED IME USE
DAT[ DAT[
FRO►II TOI
INSPECTOR'S
APPROVALS DATE
SIGNATURE
OCCUPANCY APPROVAL
IHEREBY ACKNOWLEDOE THAT I HAVE READ THIS [ROUE OCC. LOAD
APPLICATION AND ATE THAT THE ABOVE IS COR-
RECT AND T 011PLY WITH ALL COUNTY TRAIL�R SE
ORDINAN AND STA LAWS RE TING SUCH
WORK AS 1 DIC"AT ED O SAFETY PERMIT
SIONATUR F
PERMITTEE TEMPORARY
STRUCTURE APPROVED
ADDRESS 141 1, TEMPORARY
C STRUCTURE REMOVED
FEES Jed JFINAL APPROVAL
r
' APPLICATION VALIDATIOI-. JOHN F. LEWIS, PRINCIPAL STRUCTURAL ENGINEER
(NOT A PERMIT) ��CKJ) M.0. CASH PERMIT VALIDATION CK. M.0. CASH
1_��J13 9 2 �R wit
II
3 2 2 0 1 5.0 0