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DEPARTMENT OF COUNTY ENGINEER 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
BUILDING DISTRICT NO. PLAN CK.OR REc.No. PERMIT NO.
ADDRESS It .5 - — ,(,- ?y
1 - RECEIVED BY -DATE OF APPL. DATE ISSUED
LOCALITY -/-• - .
NEAREST
CROSS ST. BUILDING ?
OWNER ...,. -�,. (e•,. ADDRESS ,l�I 3 2-/ 6!A y tt
MAIL - G �1 LOCALITY
ADDRESS f�,,,. ,�,.
NEAREST
CITY • TNECROSS ST.
ARCH ITEdT OR TEL, FIRE NO. OF'- I TYPE GROUP
ENGINEER NO. ZONE PLANS
BLDG. „/' IORD. NO.
ADDRESS SETBACK LINE '-'4C-' - /"::,h _
TEL. USE ,(/� / APPROVED
CONTRACTOR NO. ZONE_ y r BY DATE
ADDRESS �OSI HOUSE NUMBERING
LEGAL MAP NUMBER r� NO. ASSIGNED BY
DESCRIPTION I LOT NO. I BLOCK
CORRECTIONS
TRACT
NO. OF BLDGS.
SIZE OF LOT I NOW ON LOT Jr1lC
USE OF NO. OF - +
EXISTING BLDG. I FAMILIES O o s�
DESCRIPTION OF WORK S c °1 3 C� r p
REPAIR (—I DEMOLITION ALTERATION '4DDITION I !. L1
2
D
r
SQ. FT. '�'”;-_ NO. OF -
SIZEROOMS -. STORIES
Wei D
EXT. WALL - I ROOF - -
COVERING I ?".P'` COVERING -
USE OF STRUCTURE Y' ,
a
CIL/ J(
APPROVALS
/Y.C-Ut/ - `4 �+ [•Q INSPECTOR'S SIGNATURE DATE
FOUNDATION: LOCATION ,-
FORMS, MATERIALS
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FRAME: FIRESTOPS, Qj
PLICATION AND STATE THAT THE INFORMATION GIVEN IS BRACING, BOLTS +"
CORRECT. FURNACE: LOCATION,
I AGREE TO COMPLY WITH ALL COUNTY ORDINANCES GAS VENT, DUCTS
AND STATE LAWS REGULATING BUILDING CONSTRUCTION.
LATH, INT. ��A�/
SIGNATURE OF A-'
PERMITTEE •:
y� LATH. EXT, �� s
ADDRESS
J
AUTHORIZED AGT. PLASTER, INT,
_
PLASTER, EXT.
$ FEE $. HOUSE NUMBER COR-
_ RECT AND POSTED
VALUATION $
FEE . FINAL
76A633A DBS 3 6-52 ' -