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1293A
( '?s 76A638A T `��_ . CE#803(REV.i l/78? � APPL[CAl'ION FOR B U ILD ING �E RM I`T' � COUNTIf OF lOS ANGELES BUILDING AND SAF`ETY FOR APPUCANT TO FIL� IN �uaoivc . � - =.D7RE55 B,;iLDIVG ,,,,,..,+ �a�,;.; " f '[i. AD�<ES� J . '+� �,�+'✓ �"„':. .�G�,�.�Y�,;;,_ LOCA'_TY ' .�. - ' ,.�' NcaREST � �'��j CIT7" i;'",/'` ':�' -i� ZIP . ' • CRCSSJT. ' . , , .. �'•.. • ' NO.C'r EsLDGS. AS�ESSOR SIZE OF LCT NOW O`J'.CT ,V�AP 600K 'AGE 'ARCEL y,. �• i : 7:$"RIC? ;oROJ? TYPE �IRE PROCESSE�BY TRACT ,,• ?t.• �: 6LOCC LOT YO. �• � CONST."`y ZONE . TEL. , . , r . . O'.YVER 1 NO � � 5 i AilS'�CAL CLASSI=ICATION SEW ER MAP AGCRESS ' CLASS NO. " DWELL.�N!TS ;�� BK '•w C?G CIiY ZIF ARCHTECTOR TEL VALUATION $ �� �'I' � ENGINEER NO �. , AvCRESS BLDG.SeTBACK FROM %'' � �,; ; FROVT-ROP LINeOF -"' '�'��-• �' !STREETI TEL :..,:.. �. - .:.. ,- CONT2AC':OR � vG. 41GHWAY + YARD - TOTALSc�BACK'ROM TYPEOF EXISiING ,��, FBON'f'PROP.LINE HIGHV�%AY �NIDTH ADDRESS �VO. t 'f = I f � f , ;-' , �i [ � �.�a.- � ' . ... �JTY CLA.,S BLCG.SET6ACK=ROM' - - ;s; i'`:: � � ;� � .F � >' ONSTZUC-ION!eNDER � 3. .-'�•:;.. i r:•�' ,, ..."..' ,J'-ISTREET� 6 �?� S.DE PROP.L�NE OF .,nA.id,E AtiD BRANCH Q TOTA:SETBACK FROM TYPE OF EXISTING iIGH'�VAY + YA2D = gIDE rROP.LINE HIGH�NAY NJIJTH � �j�.DD�ES� C'TY � ;��Q.FT��,;'""�" NO Of- NO',OF � CHECK t - �S.ZE-:.%' � - STORIES FA^AiLlE:S ONE �° � JSE ZGN� MAP � ,..s. „':�( f � ; DESCRI�T.ON OF btiORK `� • NEW ❑ r..";. NO. � `� ��-''�r� SP=CIAL ADv ❑ CONDITIONS o ALiER ❑ fINAL 6v � RE?AIR ❑ DATE {�{� 1� USE Or �E;J�C� ❑ EXIS':ING 3LDG. Z ``A'P:'C:,ti' T�� � O ;F41N?� NC ' Q 0 _ j �3";jIGVATURE. a > I HEREBY ACKVOWLEDGE THAL,I HAVE READ THIS 4PPLCATION AND STATE ' Y iHAT-F-E ABCV= IS CORRECT. AND AGREE TO COM°LY W`TF FLL ORD'NANCEJ W i+h��lAWS REGJLATING BUILDING CONSTRUCT Oti I CE eTIFY THAT:N DOING THE _ '.?'OR<AUT�IOR�ZcD NEREBY I'uJIL�NO?`_MFLCY AN''FEk50ti IV VIOLATION O� V THE LABOR CODE O°iHE SiATE OF CAJfORNIA K RELI�T!NG TC b'iORK`.1E!�'S COf.A- Z FcNSATICN,NSUftANCE.� Q � � si�n,aT��E o= �"',i.:. fr'���� ?ERMI?T�E � , ADDRESS ?�:8'�b!@'��I a��: Z O TEL. � f�.�� � '".J�t..i.��.4 CITY _NO. Q '� � ' �' � + ,�. . . , Q �i;�.�M��. �.i,s,��� �`;� P.C. Fee$ Perm�r Fee ' ' • > � :„ � �,?`. �s f j"' `'' , ,�::� Issuance Fee j.;'� o�c W G Total Fee _ . . . ,. , ... _ .._.._.,...._.....,. ..�,.�:z..,._ ___ ��,.,�,�„a,-..�._ _.. . .