HomeMy WebLinkAbout0933APPLICATION UIL INPERMIT
FOR APPLICANT TO FILL IN (Print or type only)
BUILDINGi �
COUNTY OF LOS ANGELES
ADDRESS , I
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
`
cITY zIP >
NO. OF BLDGS
SIZE OF LOT NOW ON LOT
BUILDING
ADDRESS
TRACE' / �j
BLOCK
LOT NO. �®
LOCALITY fig- %"?/ A
TE�
OWNER` , � NO o /
NEAREST
CROSS ST. (1,
ADDRESS
ASSESSOR 51((
MAP BOOK (> 11 K� {>
PAGE
PARCEL
` 66
DISTRICT GROUP TYPE FIRE
CONST. ZONE
PROCESSED BY
F i_ARCHIT
CT T ��
N�L
o! <}!p k N
ENGINEER ✓'�
STATISTICAL CLASSIFICATION
SEWER MAP
ADDRESS � . - ��
CLASS NO, DWELL,UNITS�g®f
PG
CONTRACTOR NEOL
L I C
USE,.ZONE MAP
a°p N O.
ADDRESS NO
SPECIAL
`SI CONDITIONS
LIC,
CITY ��
Ar
CLASS
ROAD DEPARTMENT APPROVAL REQUIRED
YES ® NO
CONSTRU ON LENDER
NAME AN BRANCH
BLDG, SETBACK FROM
FRONT PROP. LINE OF
(STREET)
ADDRESS CITY
HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING
SQ. F �jI' NO. OF NO. OF CHECK
FRONT PROP, LINE HIGHWAY WIDTH
SIZ (! STORIES FAMILIES ONE
fiLl
J
+ M5
,r may`
C.,.
DESCRIPTION OF WORK NEW
yg� _ ADD ❑
BLDG. SETBACK FROM
SIDE PROP. LINE OF
(STREET)
ALTER ❑
FROM
TOTAL HIGHWAY + YARD SETBACK
=
TYPE OF EXISTING
/ e
SIDE PROP, LINE
HIGHWAY WIDTH
REPAIR❑
OT �d� DEMOL ❑
+
EXISUSE
NG BLDG,
APPLICANT e �"ry®`y' TEL
CORNER CUTOFF YES ®
NO
(PRINT) NO.
IN OPEN SPACE YES ❑
NO ❑
BY (SIGNATURE)
IN COASTAL PERMIT ZONE YES ®
No
VALUATION $ (
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON-
STRUCTION, I, CERTIFY THAT IN DOING THE WORK AUTHORIZED
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR CODE OF THE STATE OF-CALIFORNIA IN RELATING TO
WORKMEN'S COMPENSAT1944 INSURANCE
SIGNATURE OF,
PERMITTEE
ADDRESSLa
TEL '
1
FINAL BY
�
CITY �"°" Na /
MAKE CHECKS PAYABLE TO;
HARVEY T. BRANDT, COUNTY ENGINEERd
FEE' 7,. FEETE
0
..
PLAN' CHECK VALIDATION �_CK.) M.O. CASH
,3 0933 5 1575 2 1 5 5.80
76A638A CE #803 5/74
PERMIT VALIDATIONS �K M.O. CASH
800