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1036 WESTWARD WAY - Building Permits
APN Owners Property Address 55 935-23-055 ROE DONNA 1027 WESTWARD WY _ 56 935-23-056 CENCI RUTH 1029 WESTWARD WY 57 935-23-057 MILLER LORA LEE 1031 WESTWARD WY 58 935-23-058 OWEN ROBERT& ELIZABETH 1033 WESTWARD WY 58 59 935-23-059 HAUSER GEORGE F/TR 1035 WESTWARD WY 59 60 935-23-060 STULIK STEVE 1037 WESTWARD WY 61 935-23-061 BARNES JOHN FRANKLIN &CHERYL KAYE 1039 WESTWARD WY 62 935-23-062 JENNINGS JO ANNE L 1041 WESTWARD WY 63 935-23-063 ANTONOPOULOS THOM 1043 WESTWARD WY 63 64 935-23-064 MARSHALL JONATHAN& ROBIN 1045 WESTWARD WY • C001C Pet a M , l J> f ) _ ditedc. ry igm.of 6/÷ CertH fusty RL-D& iris Fob ogo 1on1951 l08'G 1060 (om- w4aarlfrAft IrOv. W Y ,PR' Pum) Copyright©1996-97 Experian Page:2 of 2 APN Owners Property Address 1 935-23-001 LEIBRICK PETER FREDERICK 1098 WESTWARD LN 2 935-23-002 SMALLEY DIANE C 1096 WESTWARD LN 3 935-23-003 STIFFEY THOMAS F&TINA M 1094 WESTWARD LN 4 935-23-004 GARCIA GUADALUPE 1092 WESTWARD LN 4 5 935-23-005 LA CHAT ROBERT G&LOIS A 1090 WESTWARD LN Cr 935-23-006 MAXOUDIAN MAX&ANAHID ESTWARD LN 7 935-23-007 HOFFMAN REBECCA M 0 ESTWARD LN d 935-23-008 BAKER ALAN B 11 : ESTWARD LN 8 9 935-23-009 RISDON CARRIE J (TQLL6 ESTWARD LN 10 935-23-010 FORBESS ROBERT E 108 ESTWARD LN 11 935-23-011 SCANDONE VINCENT 1078 WESTWARD LN 12 935-23-012 WALKER DAVID S 1076 WESTWARD LN 13 935-23-013 MC QUOWN SANDRA P 1074 WESTWARD LN 13 14 935-23-014 ANDERSON BARBARA FRAZER 1072 WESTWARD LN 15 935-23-015 MOUNT KEN 1070 WESTWARD LN 16 935-23-016 VON TIESENHAUSEN ENGELBREC & LINDA L C106ESTWARD LN 16 17 935-23-017 CABANILLAS JOSE 3RD 1062 WESTWARD LN 38 935-23-018 ZINCKE CHARLES R 1064 WESTWARD LN 18 19 935-23-019 WARREN CHERELYN L 1066 WESTWARD LN 20 935-23-020 MORRIS TOM&JACKIE 1068 WESTWARD LN 20 21 935-23-021 MILLAGE GAIL L 1058 WESTWARD LN 22 935-23-022 COLLINS MAUREEN A 1056 WESTWARD LN 23 935-23-023 ENDERUD JOYCE 1054 WESTWARD LN 24 935-23-024 BROWN DON 1052 WESTWARD LN 25 935-23-025 FITCH DAVID B EST OF 1050 WESTWARD LN 25 26 935-23-026 FELIPE LEO V 1079 WESTWARD LN 27 935-23-027 FUKUI WILBUR S 1077 WESTWARD LN 28 935-23-028 GARON CHARLOTTE P 1075 WESTWARD LN 28 29 935-23-029 NORWEST MTG INC 1073 WESTWARD LN 30 935-23-030 DAILY ROBERT LEE/TR 1071 WESTWARD LN 30 31 935-23-031 HAUSER GEORGE FfTR 1061 WESTWARD LN 31 32 935-23-032 ARBALLO RAYMOND A 1063 WESTWARD LN 33 935-23-033 FERLITA JAMES TR-OF JAM FA MILY TRUS 1065 WESTWARD LN 34 935-23-034 ZEROSKI STEVEN A&THERESA M 1067 WESTWARD LN 35 935-23-035 YACOBUCCI CARLA 1069 WESTWARD LN 36 935-23-036 BERRY MICHAEL W&JUDITH M 1048 WESTWARD WY 37 935-23-037 BEVER ERIC ROBERT&TAMMY LYNN 1046 WESTWARD WY 38 935-23-038 FARLEY WALTER F 1044 WESTWARD WY 38 39 935-23-039 BEVER SCOTT R 1042 WESTWARD WY 39 40 935-23-040 MASCARO DANIEL J 1040 WESTWARD WY 41 935-23-041 BANDARUK DWAYNE&THERESA 1047 WESTWARD WY 42 935-23-042 HAUSER GEORGE FITR 1049 WESTWARD WY 42 43 935-23-043 MC KELLAR ELINOR C 1051 WESTWARD WY 44 935-23-044 PATEL VIJAYKUMAR&SHALINI V 1053 WESTWARD WY 44 45 935-23-045 HAUSER GEORGE FITR 1055 WESTWARD WY 45 46 935-23-046 YOUNG ROYCE-ANN 1057 WESTWARD WY 935-23-047 ANDERSON JUDITH A 1038 WESTWARD WY _ m 935-23-048 ALSINA SANDRA c103S !ESTWARD WY 49 935-23-049 SPIRES DENNIS 1034 WESTWARD WY 50 935-23-050 BEZICH TONY 1032 WESTWARD WY 51 935-23-051 SCHMITZ ELIZABETH A 1030 WESTWARD WY 52 935-23-052 JOHNSON DAVID N &JOAN T 1028 WESTWARD WY 52 53 935-23-053 MC MANUS MAUREEN 0/EA 1026 WESTWARD WY 53 54 935-23-054 ROYERS PIERRE J 1024 WESTWARD WY 54 Copyright©1996-97 Experian Page: 1 of 2 Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA P�CMIT NO. TRACT NO. - ICO1.•'NOS' :� BLDG.NO. 1206 1 /25/82 103.06 TL CONSTRUCTION PERMIT Z�G� G P Project Address /G•3 Ce It.t.d.s La'A447 TYPE OF CONSTRUCTION Owner O' M Phone S-!/,Q•-treys'❑ NEW 0 ADD 0 ALTERATION Address yyrarr X REPAIR 0 CONVERSION El DEMOLISH Arch/Eng. License No. 0 OTHER ZONINGNIs(a.CR EGU�jLgATIONS p D�5CRIPT�ON OF WO A'P'tra4 -ILYJ— z+-1 - 04fi - AddreSs UG 44.i &' m M1C ZONE PLNG. REF. ^) Contractoreve/ � 4",-,�,.ST• PhD^eJr•1 f+p�•eG TYPE �eO��F�'PERMIT I�• SETRAI wTpgitt*/ pING ^ ContacBUILDI . 0/L ST. PRf3PE TY LINE 'V!„�{_� )' Cr7_CO C4 /IYtecn 2I1 - 0 GRADING 0 FOUNDATION )(STRUCTURAL SIDE YARD LICENSED CONTRACTOR DECLARATION 0 TENANT 0 ELECTRICAL ❑PLUMBING ❑MECHANICAL SIIDEaYARD h !1 I hereby affirm th:.t I am licensed under provisions of Charter 9(com- RIGHT A mencing with section 7000) of Division 3 of the Business and 0 OTHER ` 1 Professions Code, and my license is in full force and effect. REAR YARD(TO P/L) N License Class T`h —I / q PROJECT DESCRIPTION /t Sicense No.Z 7 PKG.SPACE REO. V PROM D Date i h - Q Z Signature r '6' C&' C✓ SQ. FT. WORKERS'COMPENSATION DRATION OCCUPANCY CONSTRUCTION TYPE .IL STREET WIDTH 1 PARK FEE$ I hereby affirm that I have a certificate of consent to self-insure or a VALUATION o ZONE ZONING APPROVED BY flI elI„a 1 DATE ' 70'C certificate of Workers' Compensation insurance, or a certified copy , tr -"of(Section 3800, Lab.C.). GRADING CU.YDS. ACRES SPECIAL CONDITIONS: ' No.WPP%t '1379OtCompany Fike r tea o. - L :rtified copy is hereby furnished. REMARKS: . /p(Certified copy is filed with the city Building Division. EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit Is for one hundred ($100) or less). - - I certify that in the performance of the work for which this permit is Issued, I shall not employ any Pers,0.n any man err oo(as to become PLUMBING PLAN CHECK ELECTRICAL PLAN CHECK Datesubject r to/Z'Cthe l<e` SignatuCompere do (.n 3,v tea ,•` . BATHTUBS SHOWERS SO FT 79ba p"'FT �I .0 f - OW ILLI Nt. NOTICE: If after making this declaration, you should become subject TOILETS URINALS GENERATOR 0-1 KW_1-10 KW to the Workers' Compensation provisions of the Labor Code,you must - TRANSFORMER forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAVS APPLIANCE 10-50 KW 50+ KW revoked. CONSTRUCTION LENDING AGENCY KIT.SINKS DISHWASHERS MOTORS 0-1 HP 1-10 HP I hereby affirm that there is a construction lending agency for the per- SERVICE SINKS SUMPS (INC.SOLAR) 10-50 HP 50+ HP formance of the work for which this permit;Is issued (Section 3097 • - Civ. C.). Ir - • • FLOOR SINKS . FLOOR DRAINS : FIXTURES OUTLETS SWITCHES -Lender's-Name _ • Lender's Address DRINKING FOUNTAINS GAS TUBE SIGNS ' OWNER BUILDER DECLARATION INTERCEPTORS CLARIFIERS POLE LIGHTS I hereby affirm that I am exempt from the-Contractor's License Law for the following reason (Section 7031.5 Business and Professions Code: SWIMMING POOL - P TRAP LUNS I Hut.I ION Any city or county which requires a permit to construct, alter, POLES METERED SUB improve, demolish or repair any structure, prior to its issuance,also re- WATER SERVICE ALTERATION PANELS MAIN SUB quires the ap,Iicant for such permit to file a signed statement that he Is licensed pursuant to the provisions of the Contractor's License Law GAS SERVICE OUTLETSSERVICE AMP Chapter 9 (commencing with Section 7000) Cl Division 3 of the - - iness and Professions Code) or that he is exempt therefrom and the WATER HEATERS BTU OUTPUT for the alleged exemption. Any violation of Section 7031.5 by ^ Iicant for a permit subjects the applicant to a civil penalty SEWER CONNECTIONS More than five hundred dollars ($500). UI I, as owner of the property,or my employees with wages as their SOLAR TANK COLLECTORS • sole compensation, will do the work, and the structure is not Intended ' or offered for sale. (Section 7044, Business and Professions Code:The SOLAR PIPING SYS. Cal Lif jO OO ISSUE FEE S 00 Contractor's License Law tlreo not apply to an owner of a property ^"7 3 Oa APPLICATION APPROVED BY DATE// Z who builds or improves provided ro, and who does such wore t himself of ISSUE FEE / through ende M1ir own for employees,slepro hthat such improvements are not Is tended or offeredonfor sale. If, however,, the nerld building or improvement MECHANICAL PLAN CHECK SUMMARY OF FEES soldrwithin one year of completion, the owner will have Chef en - _ of proving no dill not build or improve for the purpose of sale). HEATING SYSTEM 0-100,000 BTU PERMIT G ❑ I, as owner of the property, am exclusively contracting with AND DUCTING PERMIT $_7�7D�,p�O� SMTP $Or�/2 licensed contractors to construct the project (Section 7044, Business 100,000 + BTU PLAN CHECK $ 32. `a 2. PERMIT and Professions Code: The Contractor's License Law does not apply toISSUANCE -$ • an owner of property who builds or improves thereon, and who con- REFRIGERATION 0-100,000 BTU PLUMBING $ S.OO •tracts from such projects with a contractor(s) licesned pursuant to SYSTEM - GRADING $ the Contractor's license Law). ,. a . . 100,000+ BTU • \ • PLAN CHECK $ L,� IDI am exempt under Section 8.& P:C.for this BOILERS BTU • ELECTRICAL $ i f• 1 — $ eason • PLAN CHECK $ MICROFILM $ SYSTEM REPAIR,ALTERATION Date Owner TOTAL FEE$ EXHAUST SYSTEM MULTIPLE MECHANICAL $ I hereby certify correct I have read ii io plication on thtl state that the above ty LESS AD- " • Information is cafe r ° comply with all city and county .PLAN CHECK $ VANCE PC $_ ordinances an ate 1 e ((((In t construction,and hereby a horize reoresents tiv s of pe li r o enter upon the above m ntiogetl - �f/ property to P pe• t ur � / t/ n FINAL FEE $1031 /`s+ Signature Date / Drivers' License or SS ISSUE FEE - et FINAL L CMF 0865-46 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor /O O! - A CONSTRUCTION AND PLANNING i POOL& SPA . APPROVALS Permit # Date Inspector APPROVALS • Permit# Date Inspector 1._ Temporary Electrical Service or Pole 43. Pool & Equipment Location' - - - - • -- 2. Soil Pipe-Undrgrn _ 44. Steel Reinforcement - --• --- - 3. Electrical Conduit,Utility-Undrgrn . . 45. Forms _' - 4. Electrical Conduit-Undrgrn • _ - _ 46. Electrical Bonding - -_ 5. Steel Reinforce - , , GT. 47. Rough Plumbing& Pressure Test -- - _ 6. . Electrical LIFERG48. APPROVAL TO COVER-GUNITE- - - - - - - . -. . 7._ Footings_ 49. Electrical Conduit.Undrgrn ' • • 8. Foundation. . _. . . 50. Gas Pipe, 0 Undrqrn,Test 9. .Water Pipe-Undrgrn _ , -_ 51. Backwash Lines. P-Trap7DUhdrgrn ' -- 10.. . Structural Floor System . 52. APPROVAL TO DECK - - - ._ - - - • - , 11.. Property Sewer Ling.& House Connection 53. Backwash & Receptor-Final - ' 12. . Street Sewer Connection _ - 54. Heater & Vent-Final 13.- Rough Plumbing 55. Plumbing System - Final 14. Rough Electric-Conduit 56. Electrical-Final 15. Rough Electric-Wiring 2-/-Cs-I- - 0 C.. 57. Solar System-Final - , 16. Rough Heating& Air Conditioning b8. Fencing & Access Approval . 1.7. .Ducts, in Structure .-. . _ . 59. APPROVED FOR PLASTERING -. . `.18. Ducts, Ventilating - -- . . " _ _ _ _ . 19. Gas Pipe-Rough'&Test • 60. POOL/SPA SYSTEMS FINAL , 20. Roof Framing - - 21. Roof Sheathing - A .- 22. Frame and Flashing )S NOTES: +K,R n�+l�ovy��,'Ap-,g47..7 JIA�„ T1 got 23. -Insulation thug �j Cc.c-t. �1_ mss- T r ,£715aK� olii;IXG7` V CJ' -- l� S 24. Lathing & Siding O _ n - - d , ' 25. Drywall Nailing _ 1 -S .3_.&2, IA-&-- -- ,1;Ist--. ts}?Do4J bs ta-gSZ., 26. Plaster Brown Coat - - ' • 27. Electrical Power Meter-Final _ 28. Final Electric - a -26 -$'1 CC - ' • 29. Final Heating & Air Conditioning. - - - 30. Final Gas Pipe-Test _ ' 31.._ Final Plumbing ._ - - -- '.' 321 Water Service-Final. . _ . . • - 33. : Gas Service-Fina' t. - - • 34. Solar Domestic-Final ' 35.- Landscape Sprinkling System - • 36. Sound Attenuation - 37. Handicap Regulations - 38. FINAL STRUCTURE & BUI-LDING S/c/B$ hc n .e•6Q n0. Cu_ 3o34 (lir Oec_SO4 39. Special Requirements Completed 'W2 40. Electric Release to Edison $/_Ra 11 :13 41. Gas Release to Southern California Gas Co. • - 42. CERTIFICATE OF OCCUPANCY • ' • • N��_ _ Date - ' eeeee®e ®Iee e®eee=eee�i i I I i - iI aaiaUUUItH ' HHHeel 1 tIresew - ®e1 •� 1 �t•! 1 - 1 I • 1 elf IiBt ; '� I 1 I I ' 1 l i i . _ l i- 1 I 1 I ' 1 ' i Ili ' I ' ir ■ I i I i'. ! I B h Beee■e I 1 1 11 1 • -i I 1 JuI!LFr! 1H I 1 !-1 ■ iH !Te -, • i I _T i� ■ UBBUBU ti l I I I l i I 1 1 I a 1 BeeBBt - i I ! 1 1 i I-I I-'- j- 1 1 1 Nome I I i -HT - rt 1 I l = II 4I ;f4 d I I I i ` I �'�, 912 !1 1� I7- • 111 _ 1 1 f I 1 etitil We r"IAS - i77 ;1 1 14? ', -‘it r.iiTh• -1 I ! • I I D i I' i - e foB�Bm 1r I SI a, : _i11-�,, .' III 1 1' i 1__' _ � . ,.=.1--_�_ 1 I _ • �UUU - .7 i I i I iT .,I- ' i i I I I I i 1 I . j I I I I:'.� 1 1 1 ! I i I 08 i - ! ! ! It ' ll , J 1 1 : I 1 e j ? � r l ' I I 1 1 ;�_ i 1 I 1 I e ! ' l j` �'�7`a'10 O/, I .." 1 ( . 1 1 1 I I I I , r-, , I �' fr 1 t _ I _� ii 1 1 1i I I I I i I I i t - I i ..1 ( i I i� I I l i ! I I I i . I .• 1 I . 1 _ _I- i r { f I I i I 4 � I I I i I I � ! 1�, 1 I1 � � I I j �--- ! 1 !! I; i, r 1 i i I I ! I t 1 1 I ! 1 ' i I j ' I '! I ! II __I__ I , i l y Ti� ! 1 1 -A./ 1zfx -� I r • I � I I 1 1 1 ! I I I ''?�I I I I I o� M i l 1 1 1 81 �!- 9 1 1 1 II ! I .1 I I l � f 1 1d,4 (. 1 i ! _ ; 1 1 1 i-1 I - 1 1 1 I ! -I1 ! 1 1 1 i 1 „ I i l 1 1 j i f 1 fel i I ! 1 I I� ! I 1-I I. 1, l1I 1 111ii1 I 1 1 ! 11 i_ 1 1.1•1i I ip I I I I ■I I ! 1 I I J I 1 1 B l l 1 1 ! I Y: I • I I ,. ,y 1 I • ' 1111 *1111 I e ! 111 • I ! IiI11I I1 i l i 1 f 1' Ty . ! I 1 1 l I [ I ! Hi I I I I I I �I l i � �___��I� I I I 1 I I 1 I ! £ I '.!P7 :' 17e - _ I nw11�r' ' �. I I i i I , -I 1 I 7 ' ' I I I I I 1 I 1 .I�� : I � i I t ! I I I( I ! 1 1 1 1 I 1 I l I j l 1 1 ! 1 ! I ! . i 1 I. 1 I I I l I f i 1 I I ' ! 1 L. I l i i I `�I i i I 1 I i I l l I ..' 1 I ' i • i i I ' 11 .i i ._ APPROVED I I �Hy of Costa Mesa Building Dept. Br .L </ J ._DATE_L./Zs19&. THESE PLANS MUST BE ON JOB Al! ALL TIMES MAKE NO CHANGES WITHOUT PRIOR APPROVAL OF DEPT. THE ISSUANCE OR GRANTING OF A PERMIT OR APPROVAL OF PLANS AND SPECIFICATIONS SHALL NOT BE CONSTRUED TO BE A PERMIT FOR, OR AN APPROVAL OF, ANY VIOLATION OF ANY OF THE PROVISIONS OF MIS CODE. NO PERMIT PRE• SUMING TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF THIS CODE SHALL BE VALID, EXCEPT IN SO FAR AS THE WORK OR USE WHICH IT AUTHORIZES IS LAWFUL THE ISSUANCE OF A PERMIT BASED UPON PLANS AND SPECIFICATIONS SHALL NOT PREVENT THE BUILDING OFFICIAL FROM THEREAFTER REQUIRING THE CORRECTION OF ERRORS IN SAID PLANS AND SPECIFICATIONS OR FROM PREVENTING BUILDING OPERATIONS BEING CARRIED ON THEREUNDER WHEN , IN VIOLATION OF THIS CODE OR OF ANY OTHER ORDINANCE OF THE CITY. I ��//��,,�� --4PPROY D {-� STRUCTURAL APPROVAL ONLY ICITY OF COSTA MESA PLANNING DEPT. SEPARATE PERMITS ARE REQUIRED SUBJECT TO BLDG. DEPT. REG FOR ELECTRICAL, PLUMBING, KY nit f p& DATE...)/25/x. HEATING, VENTILATING AND DIRECTOR OF PLANNING REFRIGERATION WORK — Permit # 8Ep-2-w6' fr THIS NUMBER MUST ACCOMPANY ALL INSPECTION REQUESTS FOR BUILDINGS WHERE PERSONS ARE TO i �� krg& `�`Lies BE EMPLOYED, WE SUGGEST THAT THE STATE OF CALIFORNIA DIVISION OF i Ca INDUSTRIAL SAFETY BE CONSULTED FOR ADDITIONAL REQUIREMENTS. �5 • 9iZ fi COSTA MESA BUILDING-SAFETY DEPARTMENT P,O.BOX 1200 COSYA MESA,CALIFORNIA 92626 APPLICATION FOR STRUCTURAL PERMIT For Applicant to/ Fillinle el InkOnly RECEIVED BY DATE RECEIVE4PERMIT DATE ISSUED BUILDING ADDRESS IAA bidi f/_ �2_Q/i 0,2/ 05, NO. OWNER i�t—� II .e-i. . MAIL1 pp ^� BUILDING/Q3& 4...67/7000.../ r _ / J• /� ADDRESS 2`ti �I/, TEL. ADDRES / r"j� (����J//7/ CITY a)/ZS NO. TRACT ,ear902/1QFLOCK' CONSTRUCTIO ^ JEW ADD ALTER REPAIR /M06�fIf, fI1SH LENDER We-As .f\J(t/ BRANCH i}- J / ^ O R -1.11v IAL°drd ADDRESS /`-7fJ— / VAL E ARCHITECTC ,f ��/ TEL./ S $ OR EN (NEER ,/(�ri_s/�, NOh ¢Z—J/ FIRE ADDRESS 2_442U3 .-k✓E .am` ��f�t '7' /3 ZONE TYPEIC. GROUPy / APPROVED CONTRACTOR OGS P^ BY DATE ADDRESS Z E • O.OF l/ USE OF NEO TEL. LANS j , BUILDING CITY NO. F STATE CITY YARDS APPROVED YARDS OVED { LIC.NO. Z4ft 22 LIC.NO. MAIN (FROM C/L TILDING ACCESSO BUILDING SIZE NO.SF BLOF LOT SAL NOW ON LOS (2 FRONT b . //Jsl/�vJ�'/j FT. USE OF /� / 1/ EXISTING BLDG. - SIDE L ), FT. r E Separate permits are required for L,SIDE Z�T. FT. H. C electric,plumbing and heating work. REAR 116 et.LV / FT. (.., USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& 0 3 �Ei� MAIN BLDGS. ACCESS. BLDGS. -7 �] DATE P.:11 2844 C U.P. s•'/� `�j�P APPROVED S"/ / — /& } Ist /a'j _AP ROVED /�. . 1R / DATE /-2/-77 �1�_Y HOLD FOR SPECIAL REQUIREMENTS CC ILI 0 I hereby acknowledge that I have read this application and state 'n rx C that the above Information is correct and agree to comply with m H. all laws regulating building construction, and I shall not employ Z any person in violation of trio workman's compensation laws of the State of California. / /� I hereby certify that I am properly licensed as a contractor under '� � SO. FT. �/ O • !([� N the State of California Business and Professions Code, Division 3, T E AMOUNT SHOWN UNDER VALUATION IS FOR ca D Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: Qz am exempt from the provisions of the State of California Business VALUATION PERMIT FEEa and Professions Code,Division 3,Chapter 9. $ •o /� PLAN CHECK E. 'n Signature of // /_ o Permittee -,<>�� S TAX $ u. E U Authorized Agent TOTAL PAID $