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76M444-CE 8675 9-68 MISCELLANEOUS V�APPLI ATI, N
COQ�WTY OF '..OS ANGELESBUILDI Na
DEPARTMENT OF COUNTY ENGINEER ADDRESS ^ •� l �/�J �,�
BUILDING AND SAFETY DMSION
JOHN A. LAMBIE. COUNTY ENGINEER LOCALITY
COLEMAN IN. JENKIN-S, SUPT. OF BUILDING _ NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN DISTRt,CT NO.. GROUP TYPE PROCESSED BY
CONST.:/
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BUILDING //�� MAP HIGHWAY
ADDRESS r✓ G► NO. (CIRCLE) STATE MAJOR SECOND LOCAL
LOCALITY `-Lief USE ZONE SPECIAL CONDITIONS
NEAREST
CROSS ST e d &I / 4 i!Lj3
REQUIRED YARD HWY STREET NAME EXIST.
LEGAL /pGJ//ArZ 4:5O SETBACK MJIDTH
DESCRIPTION LOT O BLOCK
FRONT
tR
� iv NO OF BLDGS. P.L.
AC�T _ ,yZ NOW ON LOT SIDE
USE OF 10 /� .� P.L.
SIZE OF LOT EXISTING BLDG. r• ,/r J `G
L-JAlk-
OWNER
MAIL /�-"
ADDRESS r,�Lap 14,641/L`G°
TEL.
CITY -Lr�.�f;'� NO
Gl
APPLICATION FOR
C.
OCOUPANCY
INSPECTION 61--l- SAFETY PERMIT C
L
C
• TRAILER USEco
L!
O
USE OF STRUCTURES OR DEVICES
LIMITED TIME USE
z c- dxJ - ,
_ DATE DATE
FROM: TO:
APPROVALS DATE INSPECTOR'S
SIGNATURE
OCCUPANCY APPROVAL
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS GROUP OCC. LOAD
APPLICATION AND STATE THAT THE ABOVE IS COR-
RECT AND AGREE TO COMPLY WITH ALL COUNTY TRAILER USE
ORDINANCES AND STATE LAWS REGULATING SUCH
WORK AS INDICATED EREON
SIGNATURE OF @ SAFETY PERMIT
PERMITTEE ��- 7-" l�,•-• -�
TEMPORARY
STRUCTURE APPROVED
ADDRFSS TEMPORARY
STRUCTURE REMOVED
FF1 S ' A FINAL APPROVAL �� r
APPLICATION VALIDATION V JOHN F. LEWIS, PRINCIPAL STRUCTURAL ENGINEER
(NOT A PERMIT) �K-) M 0 CASH PERMIT VALIDATION CK M.O. CASH