HomeMy Public PortalAbout5840 TEMPLE CITY BLVD_Miscellaneous__ 7SM4aa"CEr,.tr�s 9-6e MISCELLANEOUS APPLI A`�5O
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER Ago ESSS
BUILDING AND SAFETY DMSION
JOHN A. LAMBIE. COUNTY ENGINEER LOCALITY
COLEMAN W.JENKINS.SUPT. OF BUILDING NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN DII ICT % ROUP TYPE PROCESSED BY
° U CONST.
BUILDING p MAP HIGHWAY
ADDRESS ® NO. (CIRCLE) STATE MAJOR SECOND LOCAL
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LOCALITY USE ZONEI SPECIAL CONDITIONS
NEAREST ''
CROSS ST.
LEGAL REQUIRED YARD HWY STREET NAME EXIST.
DESCRIPTION LOT NO. BLOCK SETBACK - WIDTH
FRONT
NO. OF SLOGS. P.L.
TRACT NOW ON LOT SIDE
USE OF P.L.
SIZE. OF LOT E ISTIN L G. r
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OWNEVi
MAIL
ADDRESS
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CITY t NOL
CL
VAPPLlc#riON FOR
OCOUPANCY
I•NSPE•CTION SAFETY PERMITOK C
H
L
TRAILER USE LL
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V
USE OF STRUCTURES OR DEVICES
S
r rry
LIMITED TIME USE
DATE DATE
FROM: TO:
APPROVALS DATE INSPECTOR'S
SIGNATURE
OCCUPANCY APPROVAL
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS GROUP OCC. LOAD
APPLICATION AND STATE THAT THE ABOVE I COR-
RECT AND AGREE TO COMPLY WITH OUNTY TRAILER USE
ORDINANCESSTAT LAWS G SUCH
WORK AS INDIC E H ON. SAFETY PERMIT _
SIGNATURE OF
PERMITTEE TEMPORARY
° STRUCTURE APPROVED
ADDRESS TEMPORARY
STRUCTURE REMOVED
FEE rj FINAL APPROVAL
APPLICATION VALIDATION JOHN F. LEWIS, PRINCIPAL STRU5.TURAL ENGINEER
(NOT A PERMIT)' CK. M.D. CASH PERMIT VALIDATION cK. M.o. CASH
s5 -1s' 11.4 ON
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