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COSTA MESA BUILDING -SAFETY DEPA T T APPLICATION FOR$TRUCTURAL PERMIT• 17.?
P.9. BOX 7200 COSTA MESA, CALIFORNIA 92626
R C BY P RMIT `•B
For Applicant to Fill in Completely —Use Ink Only ry p
BUILDING A . NO�� �o9/�Op/O //d" !O IV -
aooREss Tract 10626
B UI LDtNG
TENANT M.D. Janes CO., Inc. ADDRESS O
UNIT OR
ADDRESMAILINS 2950 Airway Ave . , D-9 SPACE NO.
TR.NO. LOT BLK.
CITY Costa Mesa NO. 979-3376
CONSTRUCTION NEW ADD ALTER REPAIR MOVING DEMOLISH
LENDER Not selected
BRANCH N/A A-. /' �
OWNEa A-,v� C -6 -
ADDRESS N/A VALUE
ARCHITECT _ _ _ _ TEL. USE f
ADDRESS 3848 Cam U ZONE 39.3 TYPE GF
APPROVED
CONTRACTOR owner BY DATE
ADDRESS A
TEdLOTO
CITY 8 NOSTATE CITYAPPROVED SETBACKS
LIC. NO. 8 LIC. NSIZE NO.O(FROM C/LST T
OF LOT 5501 x 334t NOW FRQA
USE OF
EXISTING BLDG. N/A R OE FT. O
Separate permits are required for
electric, plumbing and heating work.
USE OF BUILDING AND WORK TO BE PERFORMED
PLANNING ACTION
I DATE
�J A -r /.✓]OA/rI_x �RE.%%�k APPROVED 7
Wert /L —/7- /
I hereby acknowledge that I have read this application and slate
that the above information is correct and agree to comply with
all laws regulating building construction, and I shall not employ
any person in violation of the workman's compensation laws of
the State of California.
I hereby Canty that I am properly licensed as a contractor under
the State of California Business and Professions Code, Division 3,
Chapter 9, and that such licenses are In full force and effect, or I
am ezampt from the royisions of the State of California Bysiness
antl Professions Cotl Divisi rp 3, Chapter 9.
Signature of
Permittee
°f8/17/79
Authorized Agent e
3
A
'v
4 -
37 AO 7 SO. FT.
ry `
THE AMOUNT SHOWN UNDERVALUATION IS FOR
to C\
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
VALUATION
PERMIT FEE f
PLAN CHECK S .So �• j
o
$So
TAX f
Fin
TOTAL PAID It 61-7,617