HomeMy WebLinkAbout1474A 1475A (8) I ��S 76A638A �! � � /� � . ._.�
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APPLICATION FOR B U ILD ING PE RM IT
COUNTY OF LOS ANGELES 8U{LD1NG AND SAFETY
FOR APPLICANT TO FILL IN ADDRESG OO/ "' O.3 �/�
BUILDING D� ` �r�1r�4 �/
ADDRESS 6�dJ� �r �aAutY u�� i
NEAREST
CITV >7 ..r ZIP CROSS ST. �/��
NO.OF BLDGS. a ASSESSOR
SIZE OF LOT NOW ON LOT �/ MAP BOOK PAGE PARCEL
DISTRICT GROUP TYPE FIRE P ESSED 8Y
TRACT BIOCK LOT CONST. ZONE
OWNER . N0.1 � � �'3 TC- �
/� STATISTICALCLASSIFICATION SEW MAP
ADDRESS �/ CLASS NO. O� DWELL.UNITS BK PG
CITY Z�P�1 V //////
ARCHITECT OR • TE� VALUATION $ y/��
ENGINEER � � NO. � �
ADDRESS BLDG.SETBACK FROM
TEL A FRONT PROP.IINE OF ISTREET!
CONTRACTOR NO. ��+ HivHWAY + YARD = TOTALSETBACKFROM TYPEOF EXISTING
��� FRONT PROP.LINE HIGHWAY WIDTH
ADDRE55 N4
LIC. + _
CITV CLASS '"'
BLDG.SETBACK FROM
CONSTRUCTION LENDER SIDE PROP.LINE OF �STREETI
NAME AND BRANCH TOTAL SETBACK FROM TYPE OF EXISTING �"
HIGHWAY + YARO = O
ADDRE55 CITY SIDE PROP.LINE HIGHWAY WIDTH
SQ. . NO.OF � NO.OF /� CHECK = V
SIZ STORIES FAMILIES "(�• ONE �
DESCRIPTION OF WORK NEW .C. Fee$ J � O Permit fee ��� �
ADD ❑ � W
�¢� Issuance Fee v
ALTER /� �
REPAIR ❑ /`�,. ��3 U Totai Fee ��
USE OF DEMOL ❑ ^�
EXISTING BLDG. / �� � p 0 ` 1 � 7,jr F
APPIICANT 1 � ���� TEL�r��� � ^
IPRINT� � • • NO. � O i -t
tt � � • • L �
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BY i51GNATUREI � `� l' • r Q �; (G
I HEREBY ACK OWL E THAT I HAVE R AD THIS APPLICATION AND STATE Y
THAi iHE ABOVE CO ECi AND AGREE TO COMPLY WIiH ALL ORDINANCES W � � � '+ � �� �� '.: ��_ ���
AND lAWS REGUTA 'G B ILDING CONSiRUCTION.I CERTIFY THAT IN DOING THE V � . � �
WORK AUTHORIZED H I WILI NOT EMPLOY ANY PERSON IN VIOLATION OF �I �] q
iHE LABOR CODE OF THE STATE Of CALIFORNIA IN RELATING TO WORKMEN'S COM- Z� �i !��G-C-'O �
PENSATION INSURANCE. �
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SIGNATURE 1
PERMITTEE . }t • • • • °
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ADDRESS � I' � 1( �2 C O
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GTY NO. 0 � ;° � ::G • vc.
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