HomeMy Public PortalAbout5522 GRACEWOOD AVE_Certificate of Occupancy__ APPLICATION FOR OCCUPANCY INSPECTION
FOR APPLICANT TO FILL IN (Print or type only) COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILD I NG
ADDRESS L t/ BUILDING AND SAFETY DIVISION
BUILDING
CITY'rZIP ADDRESS 2
SIZE OF LOT // NO. OF BLDGS. LOCALITY
2 NOW ON LOT
NEAREST
TRACT BLOCK LOT NO. CROSS ST.
ASSESSOR
OWNERig, TEL' 't MAP BOOK PAGE PARCEL ,
TA 0%, N0. -03�d DISTRICT TYPE FIRE PROCESSED BY
ADDRESS _- f CONST. ZONE
l
CITY ZIP USE ZONE MA
SIZE OF N0. OF NOP.-�6 D
EXISTING BLDG. STORIES SPECIAL
CONDITIONS
PRESENT USE OF BUILDING d,fA E BLDG. SETBACK FROML
FRONT PROP. LINE 0 (STREET)
TOTAL SETBACK FROM TYPE OF EXIII IN
NO. PARKING HIGHWAY } ' YARD = FRONT PROP. LINE HIGHWAY WIDTH
SPACES PROVIDED
} _
BLDG. SETBACK FROM
REASON FOR INSPECTION REQUEST SIDE PROP. LINE OF (STREET)
HIGHWAY t YARD - TOTAL SETBACK FROM TYPE OF I$TIN
1.4 VA64 SIDE PROP. LINE HIGHWAY WL
DTH
CORNER CUTOFF YES HO
PROPOSED MAX. OCC. OCCUPANCY GROUP
AS VERIFIED OCCUPANT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS LOAD
APPLICATION AND STATE THAT THE ABOVE IS COR- EXIT HARDWARE:
R ECT.
NO. OF EXITS NO SPEC. KNOWL. ❑
SIGNATURE -
PANIC DEVICES ❑
APPLICT
/ � PARKING REQ'D D PROVIDED O
ADDRESS SPACES +
ZIP
PHONE
MAKE CHECKS PAYABLE TO: A 10
HARVEY T. BRANDTIN COUNTYENGINEER FINALA' Lt���
DATE
APPLICATION VALIDATION M.O. CASH
76A662-CE992 IZ-71 .-_4i!t AY 2-7 2.2 D 1 8.0 0 *S68, .