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DEPARTMENT OF COUNTY ENGINEER
DMSION OF BUILDING AND SAFETY /j, ®I
COUNTY OF LOS ANGELES 1 �•,
WILLIAM J. FOX, COUNTY ENGINEER APPLICATION ' ' ?-
CASSATT D. GRIFFIN, SUPT of BuILO1NQ
FOR APPLICANT TO FILL-IN FOR OFFICE,USE ONLY
BUILDING 3 /(/ /q DISTRICT O. j PUN CN.OR REC.No. PER(+M/IT NO.'
ADDRESS /LQ-`�-Ilr,�ji�� 30 b 1
LOCALIT '� • RECEIVED BY i DATE OF APPL. DATEISSUED
NEAREST S/'_. J O�j-/ V'uS
CROSS 9T A' .L-L M/ Gy,�/ T7e'�/n/
ADDRESSI BUILDING CJ ,
OWNER -.
MAIL LOCALITY
ADDRESS
CIT OL / NEAREST /f 1
b CROSS ST.
ARCHIT CTOR - FIRE NO. OF TYPE GROUP'.
ENGINJR NO. ZONE I PLANS
BLDG � I I ,
ADDRESS t BETE CK`LINE r /�/yL IOl/CI NO
F
TEL. USE APPROVED �1
CONTRACTO NO ZONE ! BY, PATE
HOUSE NUMBERING
LEGAL' MAP NUMBER NO. ASSIGNED BY
DESCRIPTION LOT NO. BLOCK
CORRECTIONS--
TRACT TRACT ��Ig
NO. OF BLDGS.
SIZE OF LOT I NOW ON LOT
USEOF I NO. OF - --^-- - ---- ---------•�
EXISTING BLDG. FAMILIMS
DESCRIPTION OF WORK '` 0 -
NEW ALTERATION ADDITION D
Z
REPAIR DEMOLITION D
r
SQ. FT. NO. OF
SIZE ROOMS STORIES
EXT. WALL ROOF
COVERING COVERING
USE OF STRUCTURE
/ Y
APPROVALS
INSPECTOR'S SIGNATURE DATE
FOUNDATION: LOCATION
FORMS. MATERIALS" '
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APm FRAME: FIRESTOPS.
PLICATION AND STATE THAT THE INFORMATION GIVEN IS BRACING, BOLTS
CORRECT.
I AGREE TO CQMPLY WITH ALL COUNTY ORDINANCES FURNACE: LOCATION, -
AND STATE LA 'RE LATING BUILDING CONSTRUCTION. GAS VENT, DUCTS
SIGNATUREI9 OF ��� LATH, INT.
PERMITTE
ADDRESS T
�iw LATH. EXT.
1 PLASTER, INT.
AUTHORIZED AGT,
PLASTER, EXT.
L:L�kTION
V'O 'FEE 9 , HOUSENUMBERCOR-RECT AND POSTED FEE FINAL
76AWOA DS88 8-88 - -