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Home My WebLink About252 VIRGINIA PL - Building Permits r • CITY OF COSTA MESA >N BUILDING DIVISION / DEVELOPMENT SERVICES DEPARTMENT PE MIT NUMBER PERMIT 00-00790 �RPDXFM1��`t (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 252 VIRGINIA PL Status: ISSUED Suite: • Applied: 06/01/2000 Vicinity: HOUSE AND ATTACHED GARAGE Issued: 06/01/2000 Parcel Number 42608221 Zoning: Applicant: OLIVER, DON ISSUED BY: Address: 700 E SYCAMORE ST Phone: (714)772-7485 ANAHEIM,CA Zip: 92805 Owner: DOUGHTY, BYRON L Address 252 VIRGINIA PL Phone: COSTA MESA, CA Zip: 92627 Contractor PROSERVE ROOFING Address: 700 E SYCAMORE ST Phone: (714)772-7485 ANAHEIM,CA - Zip: 92805 License: 489090 Arch : Eng: • Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT • REROOF EXISTING SINGLE FAMILY RESIDENCE&ATTACHED GARAGE(24 SQ).TEAR OFF EXISTING COMP ROOF, INSTALL 1 LAYER OF 15#FELT UNDERLAYMENT,AND REROOF WITH 25 YEAR COMPOSITION SHINGLES. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $3,000.00• Permit: $83.25 Claim Valuation: $3,000.00 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $83.75 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 ,F DECLARATIONS U • LJ WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: 0 I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the rk for which this permit is issued. 13I have and will main .in workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My worker co, •• sation Insurer rrier and policy number are: P Carrier: ./y�� Policy Number: 4X -ace/Z-5_3 (This section n:ed not be comp •ted if the pe it/s valued;t one••ndre•dollars($100)or less.) ❑ I certify that in the •-rformance of the work f• which • is permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation law •f California,and agree t 't if I s 'uld become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these •revisions. / Applicant Signature: Ail& Date: —7 ✓ WARNING:FAILURE To SECURE '•fffir/!•(45 'w• •_ IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE '100,000).IN ADM* •THE CO OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3M6 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS • CLARATION: I hereby affirm that I am li . sed uncle p o -I ha. '-r 9(••' manning with Section 7000)of Division 3 of the Business d Prdfysslons Code,and my license is in full force and effect.Lic.tt / � Class a /37 Contractors Signatur-. ` 2 / f / r Date: 6 -7-(j/) CONSTRUCTION L NDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: • Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: • ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and tiling with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: \I Date: CERTIFICATE OF COMPUAN AND AUTHOR 110N OF E •• :I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply w' all state laws aria city ordina --s relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property r Inspection purposes.I agree • to occupy or allow occupancy of any building authorized by this permit until final inspection. S re Of L.grd e •• - / Dat .: Cr /1'•orize• -•p ice 7- Date CODE• INSPECTION TYPE DATE INTITIALS COPE* INSPECTION TYPE DATE INTRIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 6, -/c 210 Final Electrical 201 Final Block/Retaining Wall _ 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 2446-46 OWNER DOUGHTY, BYRON SEP 1 4 1960 DATE 6-13-6o JOB ADDRESS • 252 Virginia Place BUILDING PERMIT NO. 12229 GENERAL CONTRACTOR E. L. Patterson VALUE $ 495.00 AP.No.118_160_11 LOT 304 TRACTNtpt Ht s FIRE ZONE DESCRIPTION OF WORKre]orate garage INSPECTIONS DATE 71_ GROUP ,T TYPE V ZONE pig U^-'=.rground Soil U.G. Water _- _ SUBCONTRACTOR PERMITS ISSUED rground Gas DATE NUMBER O..,.bead Water and Gas Rough Heating Rough Plumbing Miscellaneous Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating, Final Plumbing Fixtures Final Gas Test Construction Pole Underground Power Rough Wiring - Trenches Forms Steel , y,7 0.- 6 - - 3 — 4,0 Floor System Steel Reinforce Chimney Re-Rod Bond Beam Sheathing Frame.and Flashing In Out ter, brown coat Fiumbing Fixtures, Final Electric Fixtures, Final ^I Building, Final (+y�M' G-l 4.-tee OCCUPANCY Form 210-5M-11-59 S-B P 12229 12. 29 FEE RECEIVEDp `COSTA MESA BUILDING-SAFETY DEPARTMENT ---S- l0' l3- ba P. O. BOX 917 COSTA MESA. CALIFORNIA FINANCE DEPT. For Applicant to Fill In Completely FF COSTA MESA PP P Y APPLICA N OR PERMIT TYPE OR PRtNT BUILDING 6/` .�/J� • . BUILDING ADDRESS �JCCOSTAMESA. CALIFORNIA For Office Use Only • OWNER fJ QDA/ ./....)04,941/1/ I RECEIPT NO. PERMIT NO y /tea MAIL 'T� '/ NEC' V BY XI/RECEIVED D /DATE ISSUES ADDRESS qv J^ }�/A*/A//11 �[ - C'//i 760 /2 /-, -fit) /� // '/ 7 TEL. BUILDINGDRESS �7\s-o? //� CITY GD.CT.4 f� T/l NO. ADDRESS '•�"XI . ARCHITECT �J/�Db/TEL. COSTA MESA. C IFORNIA OR ENGINEER2.,2., �i4-T1"E�!_SNO.fi•�'-/1// ADDRESS BO � a/-R/ Li. FIRE �{ 'T� ZONE TYPE GROUP // CONTRACTOR G . T ,L 97re, r .r' APPROVED \ ATE /7;�" 6.6 ADDRESS 2 20 .2a Aa Si • ZONING nal /� tL �i�/�// ZOryi _ 5 I NO.OF UBE OF NEtP' ell CITY (IQ c 49" /%A.P7, F / • Et? PLANS • BUILDING j /\, �Y STATEIC.N ‘0134-2.- 'i r TNOLE/ �L// LEGAL /1 J / 6 0. - // LIC.NO. b T / DESCRIPTION /�/(/,{ `// + - V / n�A 'I'/ OF LOT SIZE I NNOW oN LOTS A.P.NO. Y y '� j�fi� G / 11 r '71�� USE OF YARDS EVES / t (((/// _EXISTING BLDG. APPROVED ALLOWED SETBACK LINE FROM • (CENTER LINE ST.)( /% CENTER OP STREET REAR YARD FRONT .-J l• �7 FT. IN. SIDE YARD I LEFT I RIGHT . R.SIDE 2 ,�5/ FT. l IN. DESCRIPTION OF WORK L.SIDE �// FT. N. NEW I II ALTERATION I /fIII ADDITION I REAR /ty FT. d IN. REPAIR I II MOVING I L- II DEMOLISH I APPROVED 4v/ 111/BY DATE ,� - A2- 6-0 BUILDINGlr y NO. OF V SIZE fG, /., ROOMS STORIES EXTERIOR WALL I ROOF COVERING COVERING USE OF BD WORK TO BE PERFORMED P O C, e _0 PI AI 10I H t /4 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS PLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AO E TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION. VALUATION ,, / Q SIGNATURE OF Az" ( )f�jyL-�G,-(�f4�PLJ PERMIT FEE $f-i' PERMITTEE .. . i^- J,/��" �' / n .�� / N lo $ /(,j.6 PLAN CHECK $- °E AUTHORIZED AGENT !� ( z ,TOTAL FEE $ 4 OWNER DOUGHTY, Mr. & .Mrs. Byron DATE 5-21-62 JOB ADDRESS 252 Virginia P1. BUILDING PERMIT NO. 17125 GENERAL CONTRACTOR Owner-Bldr. VALUE $ 5570.00 AP No. 118-160-714 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Liv.Rm. & Bree2 INSPECTIONS Signature DATE GROUP I & J TYPE V ZONE R-1 Hfly—ReOf SUBCONTRACTOR F PERMITS ISSUED I /14-1-S )-23-(Z DATE NUMBER Water Rough Com. Refrig. 0 Air Cond. 0 Rough Heating X14} -f 2-23 G2 _ia�CgilJL/ be eW 7__-_'/7-6-2, 7a - ij V Rough Plumbing �(' Miscellaneous _ Prop.Swr.Line 0 House Con. ❑ St.Swr. ❑ �/ Sprinkling System ( ' I19 Construction Pole Underground 0 Power 0 yyy��7��. �� /� 7I�� RF,ough Wiring Yai'g_ _ 7.,24b42- 'S�l�I777Zd�ai,tYike.4 '1-23-L.Z. / 07$ ✓ 'Trenches U Forms U Steel Hein'. ❑ .-66 (b� '�� Floor System Bond Beam 0 Steel Reinforce ❑ Sheathing d YF,7 1O[ --.2.•`I •- & ,, - Frame and Flash'on i 1� ...-j r .-G ^-- Lathing — In l Out (.9 cr�l -r••• Plaster, brown coat ` �y t.-.-4.) R^rng. ❑ Air Cond. ❑ Final ag, Final /YL/s 9%23 ♦ .Hing Fixtures, Final / Final Gas Test /5 //ff-S t-23'42- Electric Fixtures, Final zr�./y Building, Final �' ' . OCCUPANCY FORM BU4-5M - 7-61 1(12'- r 17I2c FEE RECEIVED 'COSTA MESA,BUILDING-SAFETY DEPARTMENT MAY'171962 / P. O. BOX 311 COSTA MESA, CALIFORNIA FINANCEyDEPT. V For Applicant to Fill In Completely API'LICATI6 ° OR PERMIT ''nn��^^ TYPE OR PRINT BUILDING BUILDING ADDRESS ey.:/ a V/R.' /X / L/A . COSTA MESA. CALIFORNIA For Office Use Only O L� j 1' RECEIPT NO. PERMIT'NO. OWNER .Y)II pi NC Sy Pa At AodeHI;� i / 7 /.; s MAIL / I, RECEIVE BY Dr-RE/yE•��yED.,,II DATE ISSUED } ADDRESS a 'S 1. y i4'4j4 J 7L VE S "> / ( � I� / �I TEL. oo BUILDING `/// �n cITYC A37A M FSA 0 A (F NOL(' 'I 17I ADDRESS�s� / � k< Y1VY( j �[ ARCHITECT --.. TEL. COSTA MESA. ALIFORNIA OR ENGINEER NO. ADDRESS FIRE •,1 pp //�l(v/// ZONE ,TYPE GROUP At CONTRACTOR /1-(i(/�7LL-L 4e- BYPROVED �L _ DATE).--� � ADDRESS - Tb'/` NTNG q ZONE NO.OF U6E OF NEW �� CITY �/ I PLANS "-IBUILDIN L7- STATE TEL. LEGAL /-)1..s (� LIC.NO.�'j. n / NO. �. DESCRIPTION IJ)� 7. /a O•T' "" �/ SIZE OF LOT 4r,. 7 9�, J I NOW ON LOTNO. OF Bt,{ A P NO. �/ C) - / (g C7 J I USE OF „rYARDS EVES ' EXISTING BLDG. /i 4 Al r _ APPROVED ALLOWED SETBACK LINE FROM _ ,,Jy. �/ (CENTER LINE BT.) CENTER OF STREET an,- 2-r• REAR YARD 711 FRONT ‘5--"'.9-FT. - T. IN. SIDE YARD i LEFT e2 r RIGHT ,'S 7 - J R.SIDE G1 )3//FT. ,.C./IINN. DESCRIP ION OF WORK X L.SIDE ��f�FT. y a�. SIN. NEW 1 0 ALTERATION I II ADDITION I 7 ` REAR FT. � �• IN. REPAIR I 0 MOVING 1 I DEMOLISH I BPPROVED ar 1 O LV / DATE 5-7 7-6... �j`/ BUILDING / • NO. OF L SIZE 71! -5Iit ROOMS / STORIES EXTERIOR WALLI ROOF a OMP COVERING \:r',/ CC aCOVERING 'SW,'G / t USE OF BUILDING AND WORK TO BE PERFORMED Liv ii/F RUM if 04/11 FCON 6 TdoT --;ii )' ��tp' I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OF EBTABLlBHING w PERMIT FEE ONLY. BUY WITHALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDINGNG CONSTRUCTION. ` crib ISI �J/� Y VALUATION 1 PERMAITTEF OFR En- LE r yd IV ht 7 i• �lr�� `�+ PERMIT FEE $ r / }• n_ 1 ( $ ✓/'h /y PLAN CHECK $ /OI 5-V AUTHORIZED AGENT / £ E . ... ,. .,..... TOTAL FEE A ,TO LL •••• an,' LAAillt 1, nnlJ'uu Ifnafl µ u o0 JOB ADDRESS 252 Virginia Place BUILDING PERMIT NO. 25572 \GENERAL CONTRACTOR ARCA Const. Inc. DESCRIPTION OF WORK Comm. Block Wall Io AP No. 118-162-01 LOT TRACT FIRE ZONE VALUE $ 276.00 1 3CTIONS Signature Date GROUP J TYPE .III ZONE R-1 S�--s PERMITS ISSUED �s _ SUBCONTRACTOR I Date Number I Signature Water Plumbing ugh Plumbing Prop. Swr. Line 0 House Con. 0 Sprinkling System Miscellaneous Rough Heating and Air Conditioning (y Temporary Service or Pole v Underground 0 Power 0 Rough Wiring Heating and Vent. Trenches p Forms 0 Steel Reinf. 0 / n< /9 Floor System Bond Beam 0 Steel Reinforce 0 Sheathing Frame and Flashing Lathing—In ❑ Out ❑ Plaster, Brown Coat F ural, Final Electric 1 .g, Vent., Refrig. and A.C., Final _ Plumbing, Final and Gas Test 0 Electric, Final I Building, Final t cw" %-//6 MESA l COSTA MESA BUILDING-SAFETY DEPARTMENT , C �S P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 1966 C9TY Of APR 11�A '. For Applicant to Fill In Completely APPLICATION FOR PE IT TYPE OR PRINT _ f, I 14 0 is _ 1)F•12%,3 ;. . i - ,i BUILDING ADDRESS "11;2_ yl ICY1 INI<1.- la.[: RECEIPT NO. COSTA MESA. CALIFORNI7557 A {� R[C[I / `DA RICE/[D /y /IO '•_. OWNER Iy Ca 3u-'AN �DI�L•gh L / f 'Q r; NE - ! II lW J ; BUILDING !! J MAIL ADDRESS ADDRESS �-SZ U t 2C`��, p W.IGL. - C---FIRE . , TEL ZONE �l (I GROUP �.....-r....• CITY C0S�p (Wes Ar NO. r / APPROVED / / /!6 , , ARCHITECT TEL S' BYill) DATE '4' rtl OR ENGINEER NO. ZONING �ti ADDRESS nn • I l � ^ _ 1. /( I zuni v I sumo . CONTRACTOR u NSr2OC OA) ICC ^fir. r= 1 • ADDRESS - I .S1t (�JCCOOASl Sr. DESCe1R1oN I OL �/' j /f% CITY ITPtQ3 �M ILC,0 G C A.�' A.P.NO. 1/ ? x/6.2 V/ I NOTE: NO RAVE OVERHANG SHALL BE LESS THAN STATE eal -L2�` NO, E.jr+ to to Li , 210•TO BIDE a REAR P.L. LIC. EAVES BIZ! QQ''�� 7 `/ q r/ I No.OF NLDGe. ALLOWED .(U.S.C.REQUIREMENT) i USE OTy(,G J( ` II L NOW OIL.OTN I -�- USE OFt1 YARDS APPROVED YARDS APPROVED EXISTING BLDG. `cc S MAIN BUILDING ACCESSORY BUILDING (FROM C/L STREET) SETRACK LINK FROM FRONT PT (44Fr.6 .-et/]/'` -- CENTER OF STREET REAR YARD ,F{ SIDE YARD I LEFT I RIGHT R.SIDE FT. V FT. DESCRIPTION OF WORK L.SIDE FT. - 1.1:--- . .1:-. NEWREAR PT. I PT. �� h ALTERATION ADDITI•N DISTANCE RET. BET.MAIN& i REPAIR • INS ■ , MAIN BLD• - ACCESS.SLOGS. _ DATE BUILDING NO.OF SIZE - pp APPROVED EXTERIOR• ' COVER I NG COVERING BYAPPROVED 11C�� Ai ATE q%- I f .c 6 USE OF BUILDING AND WORK TO BE PIRFORMED /7 W F • atL" ce0P ater ic- `LW ; SQ.FT. I HEREBY ACKNOWLEDGE THAT I NAVE READ THIS APPLICATION THE AMOUNT RHOWN UNDER VALUATION IS FOR THE 1 AND STATE THAT THE AB E IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT PEE ONLY. I PLY WITH ALL CITY ORDJNA CES AND STATE LAWS REGULATING VALUATION c�fa Q •� BUILDING CONSTR CTION. O W PERMIT FEE 3 SIGNATURE OF \/"� _ 1 PERMITTEE ` ` 1 A>J7 s ^ 7 6P. 3 cc)AUTHORIZED AGENT TOTAL FEE