HomeMy WebLinkAbout0925. APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (Print or type only)
BUILDING , _z / , COUNTY OF LOS ANGELES
ADDRESS
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DEPARTMENT OF COUNTY ENGINEER
0, BUILDING AND SAFETY DIVISION
NO, OF BLDGS,
BUILDING
SIZE OF LOT NOW ON LOT
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LOT NO.
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STATISTICAL CLASSIFICATION
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ADDRESS
CLASS NODWELL,
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ADDRESS
NO.
SPECIAL
NO
LIC
CONDITIONS
CITY CLASS
ROAD DEPARTMENT APPROVAL REQUIRED
YES NO El
CONSTRUCT] ENDER
NAME AND Boq*CH
BLDG. SETBACK FROM
FRONT PROP. LINE OF
(STREET)
ADDRESS CITY
HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING
S NO. OF NO OF CHECK
Q. STORIES 0
S I FAMILIES ONE
FRONT PROP. LINE
HIGHWAY WIDTH
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HIGHWAY WIDTH
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APPLICANT TEL
CORNER CUTOFF YES
NO ❑
(PRINT) NO.
IN OPEN SPACE YES El
NO El
BY (SIGNATURE)
IN COASTAL PERMIT ZONE YES
NO
VALUATION -,I- u, ,,
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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 EMPLPY ANY PERSON IN VIOLATION OF THE
LABOR CODE OF THE S 'ITE 0 F CALWORNIA IN RELATING TO
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WORKMEN'S COMPEN.AT 'NSU R7"
SIGNATURE OF _4 1,
Idlel
PERMITTEE
ADDRESS1&!c—
FINAL BY
DATE
CITY
MKE CHECKS PAYABLE TO:
$ P
FEEC.,$ FEE'
HARVEY T. BRANDT, COUNTY ENGINEER
0 1 1
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PLAN' CHECK VALIDATION
0925 51575 21
M.O. CASH PERMIT VALIDATION M.O. CASH
A
55.80-* 0926 5 1575 1 186.00#
76A638A CE#803 5/74