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Home My WebLink About620 WHITNEY WAY - Building Permits�1 Pfltl�`��p�OF��s. El%O WHITNEY WY \ owxexsxame:�RUUKVIEW CONDOS aooRcss:HnMEOWNERS ASSOCIATION 630 PAULARZNO COSTA MESA CA ANCHIENGINEEH: ' 8 7_� 3 9 9 ROOflE55: ` v flEG.NO.: u"iT: CITY OF COSTA MESA — BiJILDSNG PERMI'i PEkN, NO; H 063354 PERMIT NO: B 063354 PLAN CHECA NO; N GOVT: N SUPP: N UNIT: PENMITTEE: MESA ROOFING ( 71 4) 548-301 2 ROOHE55: 8 4 3 W 1 7 TH CM CA 92627 LICENSEO LONTflACTOfl DELIAflAT10N: I �ereby allirm ihal I am IicenseE un�er pmvisions of CIIaO�er 9(commendng with Section 7000� ol Division 3 of Ihe Busines5 ana Pmlessions Cotle. antl my lirense is in tull �arte and elleci. cirruc.:03/i_68t sraTeuc.�6415�'.�—' &31e:.�'(fL%� Signature: _ ._ _ _ _ WOHNEBS' COMPENSATION DECLANATION: I hereby alfirm inat I have a cenificale ol consenl to sell�insure or a cetlilicate ol warkers' fAmpen5ati0n InSurance. or a cendied coOY ��ereo� �Section 3800. La�. C). POLICYNO.:P�+JC 7.41675U0 E%P.ORTE:O%�OI I9�{ comeaNr:GOLDEN EAGLE � CCfli�i¢0 [OpY 6 �¢f¢Cy Wf015h¢4. ❑ Ce�ifietl copy is ciry BuilAin Di�visiy n.� /� ,Blle: O �(/l � �j AODlicanfe��.__��'��L_JG' 1�+�— EXEMPTION FNOM WOHKEflS' COMPENSATION OECIANPiION: Qhi55eciion nee0 noi �e completea if Ihe permit is lar one AunGr[d (5100� or less�. I cetlily Iha� in ihe petlarmance o� ihe work lor wAich Ihis Dermii is issued I shall nol employ any person in any manne� so as �o become su�jecl to t�e Workers' Compensa�ion Laws al Calilomia. �a�e: Signa�ure: NOTILE: I�, afler making Ihis 4eclaraiion, you s�oultl become suGlem �o the Workers' Compensation pmvisions ol Ihe Labor CoOe. you mu9 fort�wil� wm01y wiih such pmvi5ion5 Or I�iS permit SAall be tleemetl revokeE. CONSTNUCTION LENOING AGENCY: I h¢reby a��irm Iha� there is a con5imclion Iending aBency lor Ihe petlormance o� �he woB for wM1ictl Ihis permil is i=SueA (Sectwn 3097. Civ. C�. LEN�Efl: ADUNE55: OWNEB BIIILOEH OECLARR710N: I hereby aflirm �hai I am e�empt Irom �he Conlrac�ors' State License Law for �he following reason (Seclion 7031.5 Business an0 Prolessional Cotle'. Fny ciiy of counry whic� repuires a permi� to consiNct, al�er, improve, tlemolis�. or �e0air any slmclure, prioi lo iis issuance. also re0uires ��e applicanl for such permi� lo lile a signed Slalemenl Ihal he/she is licensetl pursuam m ihe provisions a� ��e Comramors' Siale License Law (Cnapter 9(commencing wil� Section 7000� ol Division 3 oi the Business an0 Pmiessions CODe) or Ihal helshe is e�empt Iherelmm an0lne basis for Ihe alleAed exem0lion. Any violation ol $etlion 703t5 by any aDPlicanl for a Oermn sublec�s Ihe applicanl to a civil penaliy ol nai mor¢ �tun live hunEreO Gollars (55110�. I, as owner ol Ihe o�openy or my emvloyees with wages as ineir sole compensation, will eo tne work, and the ❑ 5lrutiurei5 noiintendetl orollereGlo�sdle�Seciion 704d. Business anU Pro�euionalCOtle: ihe CAnlratlar5' Slaie LicenSe Law aoes nal aoDN to an ownet ot a o�apeny wM Euilds or im0�oves Ihereon. arM w�q Ooes suth wOrk himSelOherself ar tnrougn �i5 Or her own em010yee5, pmvitletl Iha� SucA impmvemenis are noi inlenJe4 or ollere0 for Sale. It, �owev¢r I�e builUing Or impmvemeni is SoIA wiihin one year al completion. Ihe owner will have IOe bur0en oi provinA he/s�e tlitl nol �uiltl or imD�ove lor the purpose of Salel. I, as owner oi the pmpetly, am exclusively conlracting wiih licensee wmracmrs la cons�mci Ihe pmle�� ISeclion 70aa. Business ❑ anE Pmlesvons Coae: The Cantraaars' State License Law tloes wt appry io an ovmer oi pmDeny who DuilEs or improves ihereon S �' CONSTRUCTION TYPE; V—N FERMIT TYPE; 5'fR PURPOSE: AL"' JOH DESCRIPTION ; T/OFF RESHT REROOF W/TIMBERLINE 30YR COM SQ rT: 8,695 CLAIM VALUE; 8,645.00 CALC—VALUE: 8,645,00 GROUP OCC; R-3 / ��`**��i�*��R#*#*�#�*#D*�rrt��S�#x#�#**f�b*��t**8�w****##*�#�u�#��n�c•x##*#�t*#*#�#�*� 2 O N I N G R E Q U I R E M E N T S S E T B A C K 5 ------------ MAIN HUILDZNG ---------- --------- ACCESSORY BUILDING --------- FRNT: FT IN REAR; FT ZN FRNT: FT IN REAR; FT IN LEFT; FT IN RGHT; FT IN LEFT; cT IN RGHT: FT IN PARKING RE • PROV: PARCEL: 93405139 ZNE; REF NO: PLANNING N TES> .� . . iE IE it fElE i! iE iE # lE # 7f fE 1FiF,?Ell� if if iE 1E ik 1FiF if 1f # fk ### 1E if ik if # fE #!E 1E #)F!F k#!@ if fE # iF?E iF 7(� # IE # fF 3F #!f # IE # i(�!h #!E 7f iF if 1E iE IE # iE 7E 1F if ik D E V E`L O P M E N T S E R V I C E S R E Q U I R E N; E N.T S ! ZONING APPROVED BY DATE; ' BUILDING APPROVED BY ; DATE;.' p APPLICATION IS�SUED BY; • DATE; ��'/� 1E N' iF iE iF iF �F iE if 7E k If 1E.1h�if' iF iI' K' !f if if if�f Yt 3F iFiF7F t TF t�iF7F aF i f iF3FQ'3l'ii' Pr R'iF ti—' itiF itifiF z fF ii'7FitiF i4 M' N' 11' il' lf 1E iFlF�R'?s it' if if 3fiFfEiE#iFihlErtrt##it##1h3tx-iE%�#iF#itfEi4ititikiFiFitiFik#%�kiFiE%'iEit�nxiEiEiEit##iliF#%�##k#it1EiE#ihitit9Ei(��lElEillt#Il�tfif#dEiF# LEGALI2ATION:N F E E S U M M A R Y ST'AUCTURAL SEGMENT:Y HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 108,00 ,86 SMIP/NON—RES PLAN ISSUE FEE BOILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAIll DUF. TOTALS----> 108,86 0.00 0,00 108,86 108.86 ,00 kEVENUE DIVISION TOTALS--> COLLECTED; 1U8,86 OVER/SHORT; 00 BLDG PMT PLUNBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 308.00 .R6 antl who wnVac�S �or suc� D�o�ecis vnlA a conlracior(5) license pursuanl to t�e COntraCl0r5 Iale icense Law). I am aware .x.%.il. X.il..x. 1F If# * il.* %# f6 1F�IF k if fE !f 1k 1E #fE fE 1t# If ft fE # iF# 1t N-if #iF # 1tiliF 3t �EiE iFit1E iE ifiE iF fE 1liF�lfft #!t # f4ff #fh !t# lF1E if !f #!E # ff IE ffif ik Ihat prool o� ��eir Workefs Compensalion insurance s�oultl be O�oviaeE lo me. � I am eaemp� unCer Section: B. 8 P. C. I N D I V i D U A L F E E B R E A K D 0 W N m�misieason: TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST oaie: Q""ef SFR 8645 REROOF BY VALUE RESIDENTIAL �'�IOZONE 1, 00 8, 645.00 I Oo here�y cenily Ihat I am aware ol antl under5tan01�e requiremenls ol Califomia Heallh an0 Salety Code Sec�ions 25505. 25533, an0 $P]D OF FEES 255� ana Ina� Ioranyluiure building occuDanlwilVwill not�circle one) neetl�a comply wilh SaiE s�aie mtles andiherequirementstor a permit �or consimc�ion or motlihcaiion irom Ihe Air OuaLty Managemen� DisVicl. flesftlen�ial conSVuclion applications are eremp� �wm �nese piovisions. Oate: Applicanl: I �ereby cerlilythat I have read Ihis applicauon and sla�e Ihat I�e aboveinformalion is correcl. lagreeto comply wilh all ciry an0 couniy ortlinancesantl5latelaw5relaungloUwldingcanslmciionand�ereb riiereD�esentativeSOltAiScitytoeni¢ruOonlheaDove�mentianetl prapeny lorinsp/ection Gpujrpases. —Bate: ��(O � / � Sign � ' / — �!�/iCJ"� _�� . Onver's �icense oi sociai Secuniy n: I6a1-a6 W�ae—Builtling: Green—CoOe Enlorcemen�; Canary—Applicanl: Pink—Ruvenue: GaltlenraE—Fssessor "t 4�144417—�0?4441$ T�7 T IOS.S6 DATE: 07f06/93 TItlE: 14:56 - - --- ---r - � CONSTRUCTION AND PLANNING � APPROVALS PermiY �`r i. II 7. Temporary Electrical Szrvi:e or Vole � �2. Soil Pipe�Undrgrnd. , -�. Elcctrical Cond�rt Ut�,iity•Un�rgrnd. �. EieUrica� Cor.du�t�U^tl*y�rd. 5. SteEl Rc�nfo�rment 6 Elecv�cal UFER Gmd /. Foot�ngs 3. Foundat�on 9. 1":ater P��pe�Undrgmd. � � -- -- 10. Structural Floor System � --r 11. Property Seiver Lm: & No.:se �nnr,.ction � 12. S�::er Cap i3 floofDrains �. Pouqh PlumUinr� � �75. Rough E cCV�wi-Conbwt ' 16 Ro..7h Eicdnc�Yinrto � 77. Rough 1Yring Sign 18 Rough Elec[rical-T Bar Ceiling � 19. Rough Neat�ng & A�r Cor.di:�on�ng I- _ � 97. Ro,.9h F:ir.�n� F�ren.ace � 21. D..tts, i��. Str�cture 22 Oucts, Vcnt��+ting 7.3. Gas Pipe�Rough & Test I 74 Rcof Fram�^g - � Zo PCo� SYrati� r i � r 26. 'i.8ar �eihnn fSt-uc;.:ral !3: ;,�o�or�t J � 77. Frzne and Flasiting i _ 2E. La;h-ng G Sitling �2£. 'nsulaLnr_ I -1, ..7 D�,:.a' ��:a,hrg � i'. P'.asta� 3�oirn C�� -- -� !-- - -- ---- -- -� i'i? Eleetrica� Pov:er ��eter�Final _ -� � 33. Fira� E�cctr�c �'_4 F.^ : Hcatira & A-i Cocd tor.l:.r� � r35. F�n;.l Gas Pipe�Test � �---- _- -- --- --- -_' 7u. Hood ot Canopy ' 37. F,n;i Fscto�Y F�rep...ce I _ 38. Final Plumbing _ 39 LVater Service�Final 40. GasService-f�nai Gi. 5�'�� Dome>t�c�F��al �i2. BaGcf10:': PrevOnter A3. Backflow Irrigation � 44. Lendscape irngation System i �5. S�ur.d Attenuation 46. Hn-tl;cap Reyu!at-.o��s 47. F�7dAL STRUCTURE & BLILDI\G 48. FINA�PLANNING 49. Electric Release to Edi<on 50. Gas Reiease to Southern Caiifornia Gas 51. CERTIFICATE OF CCCUPAhCY No. Date Date � lospector 0 I�OOL&SPN ---r-.-T- �--- APPROVALS Permit �-` Date Inspector ' 52. Pool & Equii�ment LocaGon � _ ;� 53. Steel Reinforcement _ __, 54. Forms 55. ElEcbic.i: Eord.ry i 56. Rouqh Ptum.b�rg & Pre�sure Test � ' - t---- 57. APPROVAL TO COVER�G��NiTE I � � 58. Electncal Cnnuwr Undrgrnd. ~- t � ----�-- � 59. Gas P�pe, :_1 Ucc� g�rd., Tcs; � ---- - - -- - � 60. Bac!c�•: ash I. ��cs, V�Tr��i, C� U• di ��ntl -� 67. APPROVHL TO UECK (� � ' ' - --- ---I _---�- -- _ � j - � -. 62. 6ack�..�;n li RecaNic•.'=inc� I -- __�'-' 63. Heater & Vent-F�na� ' - ��- - - j 64. f�lumhingSys:i_m F:,,al __-____f___� _ ' 65. Electrical�F.�al _ _ _ 66. So�a� Svst��i--�i �r�_� � --- - --�- -- - 67. Fenr.in3 & Acc �.,, 4pp�u�ai J-- --' 68. APPROVED FJ:? PLAST[ftiiVG _ 69. POOL/SPA SYS�i E?AS FINAL � -� fIRE UEPT. FEQUIRE�"E��T '� I APPROYALS . . .� _ --- i � ---- � ----- � -t- -- - 70. Underprc..��. H, . o - - -- 71.Prodvc[Fn.ng':Gas ;_!Oii____ ��_-___ 72. Underqrounil Flus�_ _ _ I _ � �___ 73. Und�rmnu. S:o�. , T:�.!< l' G,.s .: 0.� . ------ - -------- -�-- I�--- - - 74. Orrrl�._..�: �i,r;- � � - __ _- __-_-__-_ t- - �. _ - _ 75. D��' L'ndm:�.� j -- - -- ----�- - � 76. Dry Standa�ne I 77. FIXEpSvSTEP'i-INAL__ I _ -}- 76. FIRE PRc�'. F�;�.qL _I � _. _ HcAITH DEPT. REQUIREi;E1�T 79. FINAL In�.�..GC'IC'Q -- - .. - � �- -- - � - 80. FODU C�I�iiFn'a�fE ISSu�D __ I__ _ l_ _ Notes: -- --- � �-- - - - --- t CMF 0569-26 City of Costa Mesa Pla��ing Department Post Office Box 1200 77 Fair Drive Costa Mesa, California 92626 (714) 556-5245 REQUESTFOR OCCUPANCY (Single Family Residential or Condominium Units) Tract No. �1 �' � — �� Lot No. � 3 � __ _ Date � — 7 � The developer of the above entitled tract desires to sell the above set forth lot prior to the time that the tract has been completed and its streets accepted by the City of Costa Mesa. The undersigned, by executing this agreement, acknowledges that (, they) {was--er ere) �'�advised that this tract has not been given final inspection nor has it been accepted by the City of Costa Mesa as having complied with the conditions of approval which were imposed by the City at the time the final tract map was approved. The City assumes no liability for the enforcement of the conditions necessary for approval other than those conditions protected by surety bond. The undersigned agrees to indemnify and hold the City harmless from any claim resulting in damage or personal injury to the undersigned by reason of the aforementioned uncompleted condition. i� � t� U t 7 c'_ •- c_�", � lesn G.UG � t97i n� Ph9 '��8�9il0iilil2i1i2i3i4i5i6 9 ��..�� BY� Purch r � sy D loper 11 nz TH LL PC(��;^��'; w,Y �1731 IRVINE 6p93�.;v;a�p, SUITE 210 . a �•�s o � c�s �c � a CMF 0569-26 City of Costa Mesa Planning Department Post Office Box 7200 77 Fair Drive Costa �Aesa, California 92626 (774) 55&5245 REQUESTFOR OCCUPANCY (Single Family Residential or Condominium Units) Tract No. V r�` �� 7� Lot No. Date � �� The developer of the above entitled tract desires to sell the above set forth lot prior to the time that the tract has been completed and its streets accepted by the City of Costa Mesa. The undersigned, by executing this agreement, acknowledges that (he, she, they) (was or werel�GL�advised that this tract has not been given final in ection nor has it been accepted by the City of Costa Mesa as having complied with the conditions of approval which were imposed by the City at the time the final tract map was approved. The City assumes no liability for the enforcementof the conditions necessary for approval other than those conditions protected by surety bond. The undersigned agrees to indemnify and hold the City harmless from any claim resulting in damage or personal injury to the undersigned by reason of the aforementioned uncompleted condition. � � � � ,` p_ � ,_ � �I � �,j . BY Purchaser . � , ^- �^ -+, ; iE:',.l �-'�.P�... . , . . p.0 G �J i977 P�1 �ig�9�1��11�12i1i2wi4i5i6 � � \ r�� _�Il.�� L.. � m� � c�s,a e a CMF 0569-26 City of Costa Mesa Planning Department Post Office Box 1200 77 Fair Drive Costa 11Aesa, California 92626 (774) 55G5245 REQUEST FOR OCCUPANCY (Single Family Residential or Condominium Units) Tract No. ��/�'2i Lot No. �� % ��. Date ��f/— / -�/7% The developer of the above entitled tract desires to sefl the above set forth lot prior to the time that the tract has been completed and its streets accepted by the City of Costa Mesa. The u dersigned, by executing this agreement, acknowledges that (he, she, they) �— (was or were� �V��- advised that this tract has not been given final inspection nor has it been accepted by the City of Costa Mesa as having complied with the conditions of approval which were imposed by the City at the time the final tract map was approved. The City assumes no liability for the enforcement of the conditions necessary for approvai other than those conditions protected by surety bond. The undersigned agrees to indemnify and hold the City harmless from any claim resulting in damage or personal injury to the undersigned by reason 6i �elaf�re��t�n�a uncompleted condition. CiTY OF CDST4 ^AESA P� . AUG 1 1 1977 pM PM 7i8i9�l0ill�]Zil i2i 3i4i5i6 ! �� 1�� A� —��..�.. _� L37 ey 11731 IRVINE BOULEVA,RD, SUITE 210 TllSTIFd, CALfFORNIA 92660 c.p�sGamc a CMF 0569•26 City of Costa Mesa Planning Department Post Office Box 1200 77 Fair Drive Costa Mesa, California 92626 (714) 5565245 REQUESTFOR OCCUPANCY (Single Family Residential or Condominium Units) Tract No. �� Lot No. Address Date �� 77 The developer of the above entitled trect desires to sell the above set forth lot prior to the time that the tract has been completed and its streets accepted by the City of Costa Mesa. The undersigned, by executing this agreement, acknowledges that (hershe; they)��was-eF were) W..ec.e,advised that this tract has not been given final inspection nor has it been accepted by the City of Costa Mesa as having complied with the conditions of approval which were imposed by the City at the time the final tract map was approved. The City assumes no iiability for the enforcement of the conditions necessary for approval other than those conditions protected by surety bond. The undersigned agrees to indemnify and hold the City harmless from any claim resulting in damage or personal injury to the undersigned by reason of the aforementioned (�ECrIVED C:TY OF C';�d hdESA ,;r�,;. . �_. i . ��..;!.:', ��. r�,�_� c � ��» hM PA1 7i8i9il0illi12ili2i3i4i5i6 � � � � BYr DeJ loper u e� — Representative THE C LL COs�9PA�y �a131 IRVINE BOUCE�hRD, SUITE 210, TUSTIN, CdLIFO PAef9� : Z�� ,.,w • City of Costa Mesa Planning Department Pon Office Boz 7200 77 Fair Drive I �j (�(� Costa Mesa, California 92626 U�WII�� (7 7 41 556-5245 CMF 0569-26 REQUESTFOR OCCUPANCY TractNo. �� `�� Lot No. Address (Single Family Residential or Condominium Units) Date r� —�a � �/ The developer of the above entitled tract desires to sell the above set forth lot prior to the time that the tract has been completed and its streets accepted by the City of Costa Mesa. �� The undersigned, by executing this agreement, acknowledges that I�e,—sFie, they)__.�»!/�/ (�uas-e+ werel �/e.'�advised that this tract has _T not been given final inspection nor has it been accepted by the City of Costa Mesa as having complied with the conditions of approval which were imposed by the City at the time the final tract map was approved. The City assumes no liahility for the enforcement of the conditions necessary for approval other than those conditions protected by surety bond. � The undersigned agrees to indemnify and hold the City harmless from any claim resulting in damage or personal injury to the undersigned by reason of the aforementioned uncompleted condition. �� 11i3i 1RVItdE BOULE�JARD, SUIT� 2l0 iilST9P7. CALI'FORNIA 92680 ..•• •• 111iL14L ••• V -/ V JOB ADDRESS 620-628 Whitney Way._ BUILDING PERM�T N0. 42512 A' 'o. 418-071-01 LOT II. _CTIONS 501� cns WATER({Q. £Ils /QZY.%L ROUGH PLUMBINGy PROP. SWR. IINE Q MOUSE CON. SPRINKLING SVSTEM MISCELLANEOUS ROUGH NEATING RND AIR CONOITIONING TEMPORARY SERVICE OF POLE UNOERGROUNO � POWER � ROUGM WIRING TRENCHES FORMS STEEL REINF FLOOR SYS EM � BOND BEAM ❑ STEEL REINFORCE � SNEATHING FRAME RNO FLRSHING LRTNING — IN OUT PLASTER, BROWN COr1T 5' 'URAL, FINAL HE. .AG, VENT., fVEFRIG. FNO A.C., FINAL PLUMBING. FINAL ANO GRS TEST /r% re i.0 SUBCONTRACTOR 195.000.00 � a:c �� !02l0 �z� , , i �, � � � .� F � W a Q y y '2' F G W F Q C1 ..1 a > � � m w a O � a z L�I x 3 � 4251.2 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA. CALIFORNIA 92626 For Applicant to Fill in Completely — Use [nk Only ADOiiESS G2o 6?z Gt4 btb G?B N�T�G QWNER�IECt2E�L �'/�E2P�OI�f_�Q�y' MAII � ✓Q� ♦ / / _ �� ADDRESS � /V. LA CITY L�� yG CONSTRURION ♦ /� LENDER // 6RANCN /L�A�j ADDRESS ARCHITECT OR ENGINEEF ADDRESS CONTRACTOq (9C ADDflESS C�TV STATE �j��l� �,7C. NO. G �� TEL. NO. TEL. TEL. NO. CITV UC. NO. NO. OF BLOGS. NOW ON LOT USE OF E%ISTING eLDG. Separa[e permi[s are required for electric, plumbing and heating work. USE OF BUILDING P.NO WORK TO BE PEFFOR� 5 v�ir o.t/�Sn � heraby ecknowledpe that I hava reotl t�ia application antl smte tnet tho above Informetion Ia eor�e<t antl aprae to comply with all laws repulatinp builtlinp constructlon, enG I 5heli not employ nnY Garson In vlolallon ot tha workman's compenfation lews ot [bo Stete of Californle. � heroby certify 2hat I am properly Iicansed as a conbactor untler tna State ot Calltornie Businaia entl Profaulone Cotla, Olvblon 3, Chapter 9, and that such licanses ere in full force antl etfect, ar I em exampt from [hB prOvislons of tha Smte of Callfornie Bucino�a eAtl Professions Gods, Dlvislon 7, Chepcar 9. s�e�=��.eor �, yC/ELtEi2 6� nr� P¢�mfttaB Authorizatl ABent 1pP, 7 PAIL o-7F«;.:�JOtS�+t� *�:*122... APPLICATION fOR STRUCTURAL PERMIT RECEIVEDBY DATEfiECEIV4D �.,.r��.. A.P.NO.�-/Q�(///�'UI I � �BUILDING ADDRESS�� u� TRACT B� / LOT W A D A i pWNER EGrZE�L+ VALUE S ��l/if u� o s � FIRE 20NE YPE GROI APPAOVED BV DATE I�=� NO.OF USE OF NEW C PLANS � BUII:DING YARDSAPPROVED VARDSAF DI5i.4NCE BET. MAIN BLDGS. VAR. �k C.U.P. q1� � THEAMOUNT THE PVRP06E ( VALVATION g i9SoBo & �ATE Oov i�O � rEci-� �-, RrQl;i?� VN UNOEF VAIU -ABLISHING A PERf PERMIT FEE S vLAN CHECK E TAX E TOTALPAID S N � m i e m N ON IS POR m FEE ONLY: � Z . SO ' N / m � 0 / 6S �