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DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES
WM. J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
BUILDINGS - n - DISTRICT NO. PLAN CK. NO. PERMIT NO.
ADDRESS." ..`(;^• s T v ' G *f T S a / �/� r
RECEIVED BY DATE OF APPL. ,tD,ATE ISSUED
NEAREST �' C�{ � / `�(.� 416
CROSS ST.
plyl BUILDING / /
OWNER ADDRESS
�'�./� `�. �A�:iJ.-.i _-� �-.fi��'�((
MAIL LOCALITY � �.C.�r
ADDRESS
NEAREST
TEL. CROSS ST.
CITY NO.
- FIRE NO.OF TYPE � GROUP
ARCHITECT OR TEL. ZONE I PLANS `-
ENGINEER NO.
BLDG. ORD. NO.
ADDRESS SETBACK LINE
APPROVED
`/L� �'�?L9�"' { _ TEL. BY DATE
CONTRACTOR ;.'y_K,
USE . APPROVED
ADDRESS ✓��-'�4v`G-' t� .� ZONE BY DATE
LEGAL I CORRECTIONS
DESCRIPTION Ir LOT NO. J /I BLOCK _ A
' , s- ' r,,� �. "
TRACT -'r
d _ � I)�:
;NO. OF SLOGS. I-
�•
SIZE OF LOT B X I NOW ON LOT
USE OF `_ V ND.OFNO. OF._
EXISTING BLDG. I FAMILIES I ROOMS
DESCRIPTION OF WORK
NEW ALTERATION ADDITION O
A
REPAIR MOVING DEMOLISH O
SQ. FT. )V NO.OF_SIZE ,j/tROOMS STORIES D>
WALL (` ROOF
COVERING I e5 COVERING CiO�a.
V
USE OF NEW
BUILDING
APPROVALS
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION, INSPECTOR DATE
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS
AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FRAME: .FIRE STOPS,
BRACING, BOLTS
SIGNATURE OF
OWNER LATH, INT.:
AUTHORIZED AGT �
v LATH, EXT.:
P. C. $ PLASTER, INT.
FEE PLASTER, EXT.
VALUATION �/ FEE FINAL l J^6 CSG'