HomeMy WebLinkAbout1153APPLICATION `iIBUILDING PERMIT ��
11
FOR APPLICANT TO FILL IN (Print or type only)
BUILDING
m _
COUNTY OF L®S ANGELES
ADDRESS
DEPARTMENT OF COUNTY ENGINEER
"°
BUILDING AND SAFETY DIVISION
CITY tF°
ZIP
SIZE OF LOT
NO, OF BLDGS.
NOW ON LOT
BUILDING f f J
ADDRESS, v � t f€f
TRACT /j
BLOCK
LOT NO.
LOCALITY �'� C a ) -
`
TEL
NEAREST
OWNER
�� NO.
CROSS ST.%G
ASSESSOR";r f
ADDRESS
r'
MAP BOOK
JGROUP
pAG E PARCEL
DISTRICT TYPE FIRE PR CESSED BY
CON5T�. ZONE ..
CITY
y ZIP% 1.
TEL.`_
tI
f
ARCHITECT OR
NO.
ENGINEER - (,
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®
STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS s -
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CLASS NO. OWELL,UNITS /,;j BK G
CONTRACTOR
TEL.
NO
USE ZONELx ✓
ADDRESS
LICE
NO
J
> CIALLIC,`DITIONS
CITY
CLASS
ROAD DEPARTMENT APPROVAL REQUIRED YES ® NO
CONSTRUItTION LENDER
NAME AND BRANCH
BLDG, SETBACK FROM
FRONT PROP, LINE OF (STREET)
ADDRESS
CITY
HIGHWAY + YARD _- TOTAL SETBACK FROM TYPE OF EXISTING
SQ. FT `, NO. OF /�
NO, OF CHECK
FRONT PROP. LINE HIGHWAY WIDTH
SIZE STORIES
FAMILIES ONE
f
c
/
��� "" +,,� ;
C� � NEW
D'ES'C F21P 7ON OF ORK
W
ADD ❑
BLDGSETBACK
SIDE PROP. LINE OF. (STREET)
ALTER ❑
_ TOTAL SETBACK FROM TYPE OF EXISTING
HIGHWAY $ YARD -
HIGHWAY WIDTH
ra
REPAIR ❑
SIDE PROP. LINE
USE OF
+ =
EXISTING BLDG,
OEMOL ❑
APPLICAN /
(PRINT) � O J .
NO�r
CORNER CUTOFF YES NO ❑
(�/
�*
IN OPEN SPACE YES.❑ NO ❑
BY (SIGNATURE)
IN COASTAL PERMIT ZONE YES ❑ NO ❑
VALUATION
1 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 ST�E OF CALIFORNIA IN RELATING TO /
WORKMEN'S COMPENSATI INSURANCE. )
SIGNATURE OF
PERMITTEE
ADDRESS a
FINAL BY.
TEL. DATE
CITY NO.
MAKE CHECKS PAYABLE TO: FE '$ FEE
HARVEY T. BRANDT, COUNTY ENGINEERP'C /7 I
�. .. 'o
PLAN'
CHECK VALIDATION K M.O. CASH ® PERMIT VALIDATION 6, CK% M.O. CASH
i . 5
Irk
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76A638A CE#803 5/74
