HomeMy WebLinkAbout6847APPLICATION I I I
FOR APPLICANT TO FILL IN (Print or type only)
COUNTY OF LOS ANGELES
DRESS ESS DEPARTMENT OF COUNTY ENGINEER
yA Aj., o BUILDING AND SAFETY DIVISION
NO. OF BLDGS.
BUILDING
^ SIZE OF LOT t®<)C NOW ON LOT
ADDRESS
TRACT ,; BLOCK LOT NO.
LOCALITY j (k
T E 1
NEAREST
p7
1== OWNER ;" NO� ®�
CROSS ST.
V;
`iu
ADDRESS �' `F>
ASSESSOR
MAP BOOK
PAGE
PARCEL
DISTRICT GROUP TYPE FIRE
PROCESSED BY
_ -CITY kV A 1,14 A, ZIP
TEL. A
CONST. ZONE
1 _
C <wzl—
A ,-T
NO. 1i ",
ENGIi EEft
STATISTICAL CLASSIFICATION
SEWER MAP
ADDRESS .` 1- , C
CLASS NO. T DWELL. UNITS
BK PG
_ — TEL. 'If
CONTRACTOR4 l f NO. °T
USE ZONE MAP
LIC.
- ADDRESS I=° NO. 4
NO.
SPECIAL
LIC. y
CONDITIONS
,N.
-r CITY �_ CLASS
ROAD DEPARTMENT APPROVAL REQUIRED
YES ❑ NO ❑
m CONSTRUCTION LENDER r/
NAME AND BRANCH �% `� �G'�y�
BLDG. SETBACK FROM
ADDRE,$ CITY /� `kl
FRONT PROP. LINE OF
(STREET)
OF EXISTING
HIGHWAY + YARD =
TOTAL SETBACK FROM
TYPE
SQ. FT. 'NO. OF NO. OF CHECK
FRONT PROP, LINE
HIGHWAY WIDTH
" SIZE..' STORIES FAMILIES ONE
DESCRIP If WORK r NEW
O
+
ADD ❑
w VA tit
BLDG. SETBACK FROM
SIDE PROP. LINE OFF
(STREETI
i II „,' ALTER ❑
❑
HIGHWAY + YARD =
TOTAL SETBACK FROM
SIDE PROP. LINE
TYPE OF EXISTING
HIGHWAY WIDTH
REPAIR
EXISTING BLDG. DEMOL ❑
APPRINANT�gJ^pf,��a l� i EOL(i��r0
CORNER CUTOFF
YES ®
NO ❑
//�f77 //�� �I 6
IN OPEN SPACE
YES ❑
NO ❑
BY (SIGNATURE( mP '
IN COASTAL PERMIT ZONE
YES ❑
NO ❑
- VALUATION
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
P THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES
,f
AND LAWS REGULATING BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE
V
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 COM-
PENSATION INSURANCE.
A
SIGNATURE OF
PERMITTEE
ADDRESS
CY�
F
BY
CITY TEL. ( }
NO.
DATE
MAKE CHECKS PAYABLE TO:
FEE
FEE
FEE
HARVEY T. BRANDT, COUNTY ENGINEER
1-Y,
CK. M.O. CASH
PERMIT VALIDATION CK. M.O. CASH
®s 76A63BA CE #803 3-75