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'GA538A CE#'803-7.88 APPLICATION FOR -BUILDING P E R I if' 1'
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
Deportment of County Engineer
County of Los Angeles. L6CALITY
JOHN A.LAMBIE. COUNTY ENGINEER NEAREST
CASSATT D.GRIFFIN.SUPT OF BUILDING CROSS
DISTRICT NO. GROUP TYPE SEWER MAP
FOR APPLICANT TO FILL IN PG-'
I CONST.
BUILDING I
ADDRESS ,. D � j STATISTICAL CLASSIFICATION
CLASS. NO. DWELL. UNIT
LOT NO. LOCK
_ UMBER'r MAP STATE YES
r Ndl �
TRACT l U ZQNE SPECIAL
SIX IN-W e}-- I NO.OF BLDGS. ' 1 CONDITIO
SIZE OF LOT NOW ON LOT / J
USE OF C 2,cle
EXISTING BLDG. .PL9& & G' Lr BUILDING EXIST.
SETBACK WARD HWY ST7LT NAME WIDTH
OWNER , D FRONT 124
MAIL �O
ADDRESS ��� elAI` AUt SIDE J
j�� /� TEL. ���j` K%IP. L.
CITY '%�/VI./'G� T`! NO. /7�1T/.p p•14 INSPEC_I RECORD
ARCHITECT OR TEL.
ENGINEER NO.
ADDRESS
TEL -7 el 72 r MOD-
C A�R�r4( /� NO.vy -4' s,_rZ '
_ FiA.• rNF/J
ADDRESS�D3 O C G_ 2-PSA G t O
DESCRIPTION OF WORK
NEW ADD ALTER REPAIR DEMOLISH
SQ.FT. B�� NO.OF / IVO.OF p l A0fO D ' LAJr,-PJ a -
.-J,--
SIZE STORIES ` FAMILIES /
USE OF STRUCTURE 5l L G I7 �1✓ �s P.M '
G i
APPROVALS
SIGNATURE OF
APPLICANT DATE INSPErTOR'S SIGNATURE
ADDRESS / FOUNDATION:LOCATION
.,,pp FORMS, MATERIALS 67
$ FV FEE $ RAME; FIRE STOPS, /-/-
BRACING,BOLTS -/J J
VALUATION $ 4M FURNACE: LOCATION.
FEE GAS VENT. DUCTS
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH. INT. .D
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND y
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES.AND LATH, EXT. 5--
STATE LAWS REGULATINC DINC�,qO RUCT
SIGNATURE OF �( t OUSE NUMBER COR-
PERMITTEE RECT AND POSTED / r ,y
ADDRESS— G FINAL 14.
IOHN A.LAMBIE. COUNTY ENGINEER, CLYDE N. DIRLAM. PRINCIPAL STRUCTURAL ENGINEER
PLAN CHECK VALIDATION 14.0. CASH PERMIT VALIDATION M.O. CASH
JACO 7 4 0 J.- APR 2 2 1 6 1 0.c 0
!�U07 �:0 3� APR 24. 1. 2 U-.0 0 �