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TewesaA'4ce lteaa a-ea APPLICATION FOR BUILDING PERMIT Z
COUNTY OF LOS ANGELES BU
INILDING
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DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY A
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
CASSATT D. GRIFFIN, SUPT OF BUILDING CROSS ST.
DISTRICT NO. GROUP 1.TYPE PROCESSED B
CONST..
FOR APPLICANT TO FILL IN r t c
BUILDING STATISTICAL CLASSIFICATION SEWER PRAPS
ADDRESS Q JZ" % K/
CLASS. NO. WELL.UNITS
LOT NO. BLOCK MAPSTATE YES
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NUMBER HWY.
TRACT Ur^+E ZONE SPECIAL
NO.OF BLDGS. H 1 CONDITONS
SIZE OF LOT NOW ON LOT 00� "v _
USE OF //Jg
EXISTING BLDG. I%1.'ri&ZP BUILDING YARD HWY STREET NAME EJ ST.
n� � SETBACK WIDTH
OWNER = �CAa FRONT I
MAIL _ P.L.
ADDRESS •>w SIDE
TEL. P.L.
CITY NO. INSPECTION RECORD
ARC ITEGT O TEL.
ENGINEER NO.
ADDRESS
TEL
CONTRACTO 1 NO. OJ
ADDRESS 0 �Y-C *d..`�
DESCRIPTION OF WORK
NEN ADD ALTER REPAIR DEMOLISH / ``LD
SQ. FT. NO. OF NO. OF S7V CO 6- I—L
SIZE L STORIES FAMILIES
USE OF
STRUCTURE-
SIGNATURE SIGNATURE OF
APPLICAN
APPROVALS - DATE INSPECTOR'S SIGNATURE
ADDRESS f'LQ �G FOUNDATION: LOCATION
FORMS, MATERIALS - f`�L� L T''YlF•'
VALUATION $ Q`� FRAME: FIRE STOPS, ` >
pp BRACING,BOLTS
FEE $ d6 FEE ; � FURNACE: LOCATION,
P.C. GAS VENT,DUCTS
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1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- -
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND
LATH, INT. _ -
AGREE TO COMPLY WITH ALL COUNTY ORDINAN ES AND L"+t-
STATE LAWS RE LATING BUILDING N C ION. LATH, EXT.
SIGNATURE OF HOUSE NUMBER COR- /
PERMIT fJ / RECT AND POSTED
ADDRESS LL G NAL
CLYDE N. DIRLAM, PRINCIPAL STR RAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
Wt�o6895 - ! 3 5 2 3 A 1350 ;,
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