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ADDREBB 9 O
_ APPLICATION NEARv
ES
DIVISION OF BUILDING AND SAFETY NEAREST
CROSS BT.
Department of County Engineer DISTRICTNO. RECEIPT NO. PERM IT NO.
County of Lae Angeles S 9 39 73 7
CABM. .DFOX,COUNT r ENGINDF Ba ERNR GROUP DATE RECEIVED OAT[ISSUED
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FOR
APPLICANT TOFILL IN N � ISSUED W
OWNCRp /JL7/ /2IQCA`LIL/vMA E YCB
MAIL P UMBER o HWY
ADDRESS •lh
USEZONE SPECIAL
CITU Lf NEL T R_/ CONDITIONS
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ARCHITECT OR TEL ��UV
ENGINEER N0.
BUILDING YARD HWY STREET NAM[ EXIST.
SETBACK __ WIDTH
ADDRESS //�� .ltiFRONT D I (O
CONTRACTOORRf{�AeO eG/VfTC/No/frr SIDE l
ADDRESS
DATE CORRECTIONS INSPECTOR
AD13RC1I/yAy1. Lrr t T re_ ,t
LOT NO. -ScCAff. L /
e if BLOCK /
_TRACT J4 Ntll IVII-A ZAIVOw .R/zj- _
AIZE OF LOT JIIV S( NOW ON LOT
USE OF Z_
FXI9TINO BLOO.
ESCRIPTION OF WORK °n
a
NEW ADD ALTER REPAIR DEMOLISH I
SC. FT. h r� NO. OF NO.OF
SIZE 1310 or
� FAMILIES /
USE OFSTRUCTURE
T
NO. OF
EMPLOYEES
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP-
PLICATION AND STATE THAT THE INFORMATION GIVEN IB APPROVALS INSPECTOR'S SIGNATURE DATE
CORRECT.
I AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FOUNDATION: LOCATIONG
ANO STATE LAWS R/O[i/ULATING BUILDING CONSTRUCTION. FORMS,MATERIALS
y �, FRAME: FIRE STOPS.
SIGNATURE OF✓////J .�f //`�.�I�� /f . BRACING.BOLTS
PERMITTEE / L /
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FURNACE: LOCATION. i
A9 VENT.DUCTS i
ADDRESS - d1 'p.-� !!•0, q
LATH. INT.
AUTHORIZED AGT
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$ FEE B HOUSE NUMBER COR-
/� RECT AND POSTED O V J
VALUATION - In
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rEE O� c FINAL
76A639A DB5 3136 S54 t
TEAS.. ,ttt PPLICATION FOR BUILDING PERMIT 1
DIVISION OF BUILDING AND RAFETY BUILDINGDep2A .S
- C mount,, Ot LOOS Aof nADDRESS gpltp LoeA,In a
WM J FOX COUNTY ENGINMM NEAREST1 1
CASSATT D GRIFFIN SIP T of BUILDING CROSS QT l/✓
FOR APPLICANT TO FILL IN DISTRICT NO. GRouP E p L Ar
BUILDINGMAP
ADDRESS J ��yL. N MBER �HWY Y
MS
LOT NO 4- BLOCK H USE ZONE SPECIAL
TRACT M, 3, 6 Ai1 CONDITIONS
SIZE OF LOT `/SCJ' I NOW ON L0T0. BUILDING YARD HWY STREET NAME EXIST
SETBACK I I WIDTH
USE OF FRONT
NG G P L
OWNER SIDE
P
MAIL ! A - O TRACT DWELL I UNIT
ADDRESS 7
8 INDUSTRIAL
TEL _ 1 DWELL 1 UNIT 6CITY Nn PUBLIC BLDG
ARCHITECT OR TQL Z DUPLEX I UNIT ON ALT ETC
ENGINEER NO $ APF _{IN 14B MISCEL
ADDRESS 1 4 COMMERCIAL
CONTIL INBPECPION RECORD
TRACTOR NO
ADD ESS l
DESCRIPTION OF WORK
NKIN ADD ALTAR REPAIR DEMOLISH �C^
:,*,,7
G FT NO OP FA OF
pIZQ O STORIES
NO OF
USE OF STRUCTURE
TO f h W
BIONATURE OF /I
APPLICANT `` APPROVALS
ADOREBS J DAYS INSPECTOR tt ATUSE
FOUNDATION LOCATION '/ e✓
Od P/ C. t PORN$ MATERIALS FEE FRANK FIRE STOPS '
VALUATION BRACING.BOLTS - � A �. `rI
FURNACE LOCATION.
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS GAB VENT DUCTS
APPLICATION AND STATE THAT THE ABOVE IB CORRECT I
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH.INT /7
AND STATE LAWS REGULATING BUILDING CONSTRUC-
TION `yy -y/ l�. f �.�
// �rVVI�I ti7T�.Uo t yl, LATH,mcr
SIGNATURE OF HOUSI NUMBER COR-
P0IMITTEK RECT AND POSTED
ADDRESS I FINAL _�
WM.J PDX.COUNTY ENGIN®t VALIDATION C. N DIRLAM, CHIEF BLDG. INSPECTOR
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