HomeMy WebLinkAbout1161APPFOR il
FOR APPLICXNT TO FILLLIN (PICATIONrint or type only) BUILDING PERMIT if
COUNTY OF LOS ANGELES
ADDRDIENG /y BUILA`
SSJ_ e):�, -7q��
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
CITY zlp&Z&
NO. OF BLDGS,
SIZE 0 F LOT NOW ON LOT
T
BUILDING
, " , 1 /v w e-,-, /v;I_X�
ORES ae�
ADDRESS z
.
/t -I eq/d
TRAC
BLOCK
LOT NO.
LOCALITY
V ,
T z56 Z(
OWNER N
NEAREST
CROSS ST
ASSESSOR
ADDRESS
MAP BOOK
PAGE PARCEL
P
FIRE '�o CESSED BY
DISTRICT / GROUPTYPE
CONST
. ZONETEL
CITY Z I P
/1K _
ARCHITECT05"
Not 74
;vz-
ENGINEER AVzw/ .
STATISTICAL CLASSIFICATION SEWER MAP
k2zA ,I/
ADDRESS�q
JO
CLASS NO. DWELL,UNITS B K "f yG
TEL._
CONTRACTOR. TENO,
*USE ZONE MAP
NO.
Li
SPECIAL
ADDRESS NO
12 9 LICX
CITY
P2!k-/
CONDITIONS
4M�1'—� C L S S
ROAD DEPARTMENT APPROVAL REQUIRED YES NO
CONSTR(JCTION LENDER
NAME AND BRANCH
BLDG. SETBACK FROM,-';"/
C
k4 LI
FRONT PROP. LINE Oi,Z-4EET)
• ADDRESS CITY
HIGHWAY + YARD TOTAL SET"CK FROM TYPE OF EXISTING
SQ. F NO. OF NO, CHECK
Yeresl
FRONT PROP. LINE HIGHWAY WIDTH
SIZE STORIES FAMILIES ONE
0 NEW
+ 14
OF WO DAC R�_P 1
Lj
BLDG, SETBACK FROM -/'-(STREET)
-1
ADD
SIDE PROP. LINE OF
1-7
•ALTER L-i
` S
ITOTAL SETBACK FROM TYPE OF 1EXISTING
HIGHWAY + YARD M
1
REPAIR❑
SIDE PROP. LINE HIGHWAY WIDTH
USE OF
DEMOL
EXISTING BLDG.
--TE OVj;"j
APPL=NZ6-t/,?,7- _ ILIC
(PRINT) N
CORNER CUTOFF YES NO
BY (SIGNATURE)V
Ze
C-
IN OPEN SPACE YESO NO 1:1
Z
IN COASTAL PERMIT ZONE YES ❑ NO ❑
VALUATION$ 1- cj-,
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 ANT PERSON IN VIOLATION OF THE
LABOR CODE OF THE STATE 0 'CALIFORNIA IN RELATING TO
WORKMEN'S COMPENSAT/N INSURANCE.
SIGNATURE OF.Z//
PERMITTEE
ADDRESS
FINAL BY
TEL.
DATE
CITY NO.
I,$ PMT,:
$
MAKE CHECKS PAYABLE TO
FEE, FEE
HARVEY T. BRANDT, COUNTY ENGINEER
PLAN CHECK VALIDATION (' M.O. CASH PERMIT VALIDATION," cx) M.O. CASH
2 1
6 �,2 S)
76A638A CE*803 5/74