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HomeMy WebLinkAbout3163 MADEIRA AVE - Building Permits Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. - CITY OF COSTA MESA - PERMIT NO. _ TRACT NO. LOT N99 BLDG.NO. CONSTRUCTION PERMIT 0 /�7(pS 53� G� I 0904 6/ 1 /83 • 0.00 IL a I� 1 T �j, �p� �y • Applicant's Mailing Addlgss - —, -•• • ..A s - TYPE•OF CONSTRUCTIQ(g- -• ❑ NEW I „ADD LJ ALTERATION LJ REPAI R • ellier Project Address .eariar/- J U CONVERSION .0 DEMOL}Qi bTHER - ' Owner's Name / 4 �� •h� 5:�S/' DESCRIPTION OF WORK r ZONING REGULATIONS Address - .4( o TYPE OF PERMIT U GRADINGI-U FOUNDATION 0 STRUCTURAL A.P.sle ZONE ' Arch/Eng. • - - -License No. ❑ TENANT ❑ ELECTRICAL I!�PLUMBING 0 MECHANICAL PLNG.REF.3M BUILDING • el- Address - 01 El OTHER TO BUILDING cFARn CTC rr • .PROPERTY LINE REAR YARD (TO P/L) Contractor's Name Phone PROJECT DESCRIPTION SQ. FT. OCCUPANCY - CONSTRUCTION TYPE VALUATION$ LEFT SIDE YARD RIGHT SIDE YARD Address(mailing) • - ZONE GRADING CU.YDS. ACRES PKG.SPACE REG. PROVIDED License No. - _ - LICENSED CONTRACTOR DECLARATION Remarks: L - ' STREET WIDTH PARK FEE$ I-hereby affirm that I am licensed under provisions of Charter • •mmencing - . with section 7000) of Division 3 of the Business and Pro ons Code,and SPECIAL CONDITIONS: my license Is In full force and effect. Ucenie Class - - ' • PLUMBING . - ' Date' Signature Bar Sink Sewer CapELECTRICAL ' ' `b KERS'COMPENSATION DEC • -ATION - - - - _ ;—,by affirm that I have a certi e of consent to seif4nsure or a certificate. -- Backflow Preventer - Sewer Connection Automatic Washer. 'Meter Dover 100 amps . . - - - 0; Workers' Compensation - rance,.or a certified copy thereof (Section _ - 3800, Lab. C.) I Backflow Irrigation • Solar_Collectors Construction Pole Sub Panel Policy No. Company - - - Cooking Unit Sub Pole 9 Certified -•y is hereby furnished. • Bathtubs i Solar Piping Certs copy Is filed with the city Building Division. ,• Dishwasher • Motors ❑0-1 HP ❑1 h-8 ' oat, Applicant Clarifiers Solar Tank EX MPTION FROM WORKERS'COMPENSATION DECLARAT • - Dryers ❑Gas ❑Electric (This section need not be completed if the permit is for one •• ed ($100)or Dishwasher Swimming Pool w/She Inc.Solar ❑9-75 HP ❑16-15+ , less). Fan - Microwave I certify;that In the performance of the work for • this permit Is Issued I Drinking Fountains Urinal • i 1 shall-not employ any person in any manner -s to become subject to the ( F.A.U. • Pole Light ' Workers' Compensation Laws of Californi. Floor Drains Water Closet • •• • Date' Signature - Fixtures • NOTICE: if,after making this de . ation, you should'become subject to the - Floor Sinks ' --- - Water Heater- - , - Workers'.Compensation prov •ns of the Labor Code, you must forthwith, Device Boxes ' comply with- such prov •ns'or this permit shall be -deemed' revoked: ' Gas Service Outlets 3 Water Service . _ , Sign CONSTRUCTION •ING AGENCY s„ Outlets I hereby affirm t• here is a constructlondending agency for the performance • Interceptors .- Standing Sections of the wo or which this permit Is issued (Section 3097 CIv. C.). Lander' •ams Kitchen Sink . - - Switches Trash Compactor ' ••er's Address CiWNER'BUILDER DECLARATION Lavatories Garbage Disposal I hereby affirm that I am exempt from the'Contractor's•Llcense Law for the - Generator ❑0-5 KW ❑5-15 KW ' following reason (Section 7031.5 Business and Professional Code: Any city or P—Trap. . , , . county which requires a permit to construct,alter Improve,demolish or repair Transformer ❑15-50 KW • any structure, prior to its Issuance, also requires the '-applicant for such permit Roof Drains . - [ tile a signed statement that he/she Is licensed pursuant to the provisions of ' _ ❑50+KW • t i+ontractor's License Law(Chapter 9(commencing with Section 7000)of Reinspection Fee $15' • ,';'',Clan Reinspection Fee _ oo 3 of the sis and ProfessionseCode) or that he/She of exempt Showers Pe $15 �z ,1.5 by and the basiscfor the alleged txsmjects eY ppli inn'of Section - Meter ❑Up to 100 amps Issue Fee $ 3 •JG5Jtany re aant for a permit subjects the applicant to a• civil _ an ty of not more than five hundred dollars($500). Service Sink Issue Fee $ 3 Zoning Approved By • Date ' U.1, 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 . MECHANICAL Application Approved By • Date for salee doe 4, Business and Pf a Propelrty Code: The Contractor's es License Law does not apply to an owner of a property who builds or Improves Boiler - Refrigeration System Application Issued thereon,'and who does such work himself/hornet/ or through his or her own pP By Date employees, provided that such improvements are not Intended or offered for - ❑0.100,000 BTU ❑100,000 BTU sale. If, however, the buildinghave or Improvement of nt is sold within oneyear of com- Duct-Under•Ground I platten, the owner will have he burden of proving he/she did not uild or im- • SUMMARY OF FEES prove for the purpose of sale). Duct-Structural System Repair/Alteration BUILDING PERMIT $ SMTP $ VI,as owner of the property,am exclusively contracting with licensed con- ' - tractorsto construct the project (Section 7044.Business and Professions Code: Duct_-Ventilating _ - - , PLAN CHECK $. PERMIT The Contractor's License Law does not apply to an owner of property who • • builds or Improves thereon, and who contracts for such projects with a con- Exhaust System ❑ Multiple 0 , ♦PLUMBING $ 5-- • ISSUANCE $ tqry�clor(s)license pursuant to the Contractor's License Law). PLAN •CHECK $ GRADING . $ H I am exempt under Section B.& P.C.f r this reason ' ' Firepl/Fact.Bit. ICBO# I1 / ELECTRICAL $ $ ' Date A iP Owner 1:40.4 6-42.1144.. . Heating System& Ducting - MICROFILM $ 1 her c rti that I have read this application and state that the above = - 00-100;000 BTU 0100,000 BTL - PLAN CHECK $ • informa�is'correct. I agree to comply with all city.and county ordinances - 1 • • TOTAL FEE , $ ' and-state laws relating to building construction,rand hereby authorize repre- ' Hood or Type I ❑ - MECHANICAL $ senpatives of:this:city to enter upon the a eve-mentioned property_for : ' Reins action Fee $15 1 LESS r i inspection our os G /qY%X3 l Canopy/ Type II ❑� p PLAN CHECKi $' • Signature re, Li L Date ' 1 1 „ ADVANCED PC $ Registers I • Issue Fee • $ 3 1 1 - j ' `Drivers' License or SS • � 9 ! 1 FINAL FEE'- $ 15-� =6\6 rev.12/81 White-Building;Canary-Applicant;Pink-Accounting:Goldenrod :Assessor - ' - . o POO' - SPA - , • CONSTRUCTION AND,PLAfV ING - ., - - ' ' 7gi-Sb - r`Date- ,inspector . Date Inspector - 'APPROVALS Permit#' APPROVALS I--..nit# 1. Temporary Electrical Service or;Pole . - •' .'52. Pool &.Equipment Location - - - 2. Soil Pipe-Undrgrnd.' - • . .4 - _ :53: Steel Reinforcement - : , • ' i 3. Electrical Conduit Utility-Undrgrnd.' •54:' Forms;; - . ' 4..Electrical Conduit-Undrgrnd:. L., _ . `55: Electrical Bonding ' _ ' 5. !Steep Reinforcement - - -56.- Rough Plumbing&Pressure Test - 6. Electrical UFER Grnd. - - -57. APPROVAL TO COVE R-GUNITE • , 7. Footings . _ - _ . 58. .Electrical Conduit-Undrarnrl. • 8. Foundation • '• . , .. e,59. Gas Pipe; 0.-Undrgrnd.,Test - 9. Water Pipe-Undrdrnd. i 60. Backwash Lines,:P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK • 11. Property Sewer Line&House Connection 62. Backwash & Receptor-Final- - • , 12. Sewer Cap - '- :63. Heater& Vent-Final 13. Roof Drains _ '64. Plumbing System: Final - - 14. Rough Plumbing ' 65. Electrical-Final .• 15'. Rough'Electrical-Conduit' - - T -1 ' - , 7 66J-Solar System-Final . _ . ,16.,,Rough,Electric Wiring. .-i : - 7- - : 67.-Fencing & Access Approval . - _. . - 17. Rough Wiring Sign -:. 1 ` _ 68. APPROVEFOR PLASTERING ' 1A:3Rough Electrical-T.Bar Ceiling I. . •- . • 69.' POOUSPA SYSTEMS FINAL . O • ' 19' ,Rough Heating &Air Conditioning •• ! i •• I ' ' I FIRE DEPT:REQUIREMENT , 20: Rou h�•Factor Fire lace i ' • I ' f • 9 Y P + APPROVALS Permit# _ .. - • - 21. Ducts,in Structure I , 70. Underground Hydro ' '22. Diucts, entilating . ' I i ' 71. Product Piping 0 Gas 0 Oil 23. Gas Pi I -Rough & Test _ , ? I 72.i Underground Flush - • ..' 24. Roof//Framing - : 73.! Undergrnd.Storage Tank 0 Gas 0 Oil 25. Rhof Sheathin J 9 , r . 74. Overhead Hydro 26. T-Bar Ceiling (Structural),& Monocoat : ' : '- '75.: Dray Chemical ' . , / 27 Frame and Flashing i • 76. Dry Standpipe . • 28. Lathing& Siding. - ' , , : i 77., FIXED SYSTEM FINAL , 29. Insulation -- - , ' 78. FIRE PREV. FINAL 30. Drywall Nailing • , , l , Notes: • , I 31. Plaster Brown Coat 1, ' I ' ' -•-_l' I I I 1 - 32. Electrical Power Meter-Final ' . ! I ri'• ' • ' ' - 33. Final Electric _ , • , , I • I. I ' 34. Final Heating& Air Conditioning , i • I . 35. Final Gas Pipe-Test -- 1x221: /�Qe , - . 36. Hood or Canopy. '. ' ,' 37. Final Factory Fireplace I - 38. Final Plumbing I ' a i , . ' . ' i 39. Water Service-Final' • I _ • 40. Gas Service-Final i • 27-,e4 Z 1 - 41. Solar Domestic-Final - - ._ _ ) 42. Backflow Preveriter, • . ' •, • , 43. Backflow Irrigation. .' . - 44. Landscape Irrigation System ' • 45. Sound Attenuation I I ' ' • 46. Handicap'Regulations- - , ' 47.-FINAL STRUCTURE & BUILDING , . ` . 48. Special Requirernents Completed ! . ' ! I 49. Electric Release to Edison, ._, ,__ _ 50. Gas Release to Southern California Gas Co ! ' ' a • 51. CERTIFICATE OF OCCUPANCY I ' _ ._ -__ t' No Date OWNER SYCAMORE LAND CO DATE 6-29-59 JOB ADDRESS 3163 Madeira Ave. BUILDING PERMIT NO. 976)4 GENERAL CONTRACTOR Malgren Const. VALUE $ 17,322 AP. No. LOT 86 TRACT 3367 FIRE ZONE DESCRIPTION OF WORK res aft gar Ir.-SECTIONS Ly/ DATE I GROUP I & J TYPE V ZONE R1 l rground Soi17 .4tU.G. Water LW SUBCONTRACTOR kr Y PERMITS ISSUED Underground Gas kW R- �h'q DATE NUMBER Overhead Water and Gas """III Rough Heating k ? - ants 1 . it, 1. h-°S_s t al D 62/6-V7 Rough Plumbing W eke...4? 2/tr. 4 - 2-45=ri /99 PS / Miscellaneous // 'p,i r0 Prop. Swr. Line House Con, St. Swr. il/-//,-5 � _; , 4 �/F-"S9 ODD 1)V,''lP'"�' Sprinkling System r 91 Heating, Final • ,L jt/ ,7 I Plumbing Fixtures Lf/ `- A Final Gas Test 4 ,a�--�. av Lief Construction Pole / .< .-4 l,. ' , 9-/3 1)1 . Underground Power „—_gin / Rough Wiring f '5 4 2 3 59 i//.l�Jv-cc_ F e 9- c /h o $/� J Trenches("elkForms¢/'' -Steel Lj - 1--lc-t a Floor System ,i l,�'1/� 1-- --5' Steel Reinforce Chimney Re-Rod Bond Beam Sheathing arr�q C/_/6 -97 F e and Flashing /igj -9 5 • L- .ng, In 04- Out , 4d- 1-2221 -9,' Plaster, brown coat ' ld --.25--51 Fixtures, Final :nap _ Electric Fixtures, Finalf Building, Final P ) r 's- ' "D I OCCUPANCY 1 Form 210-3M-459 i, • _ .9764 •_r ;e L..1/4.4 ' ; L. COSTA MESA BUILDING-SAFETY DEPARTMENT N ITI° i� P.O.BOX 317 COSTA MESA, CALIFORNIA Itl'�111 SII Lr FOR APPLICANT TO FILL IN COMPLETELY APPLICATION FOR PERMIT TYPE OR PRINT BUILDING ADBUILDING c3«3 /%l OL 4is. DRESS / FOR MESA, CALIFORNIA FOR OFF/CE USE ONLY RECEIPT NO. I P° Y/V 7G / OWNER sycamore Land Co ADDRESS 10835 Santa Monica Blvd. RECEIVED BY I DATE RECEIVED ATE IS6UE0 Los Angeles 25 TEIBr2328/ BUILDING . CITY NO. ADDRESS ARCH"'ECT LIC. COSTA MESA. CALIFORNIA OR F JEER' .0 Major NO. '. ADDRESS 11015 S . Paramount Blvd. Zo E E Y V }i, ' CONTRACTOR Malgren Const LIC.NO. 53335 APPROVED BY DATE ADDRES 0 ZONING • 35 Santa Monica Blvd.. LEGAL LO } ZONE NO.OF USE OF NEW DESCRIPTION NGT. 86 1 BLOCK ITRACT336. ki II PLANS/ e I BUILDING APPROVED /�•'✓Y_"`O'� �9����^^`�000/1', A.P.NO. BY G DATE C1 OF LOT 102.04 X 69 I NO.W BL. SIZE O YARDS NOWW ON LOOTTREQUIRED ALLOWED USE OF (CENTER LINE ST.) �` EXISTING BLDG. FRONT , (/ FT. IN. 1 SETBACK LINE FROM 50 24 CENTER OF STREET REAR YARD R.SIDE .(,�5-_ FT. IN. SIDE YARD I LEFT 5 I RIGHT 5 1....SIDE v FT. IN. DESCRIPTION OF WORK REAR if) FT. IN. . NEW I XI ALTERATION I II ADDITION I REPAIR I II MOVING I II DEMOLISH I NO.OF SIZE BUILDING 1746 ROOMS 6 STORIES 1 EXTERIOR WALLS'bleed ROOF wood. shingle COVERING I COVERING • USE OF BUILDING AND WORK TO BE PERFORMED I, •I - a . - • . 3B Att. Garage ; I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY OR INANCES AND STATE LAWS REGULATING BUILDING CONSTRU A VALUATION • SIGNATURE �rap r v /Y/ PERMIT FEE $ 7 PERMITTEE �l gyp - Z �����IICCCN//AAA...�+-L.L/f/ �� q /n/ /, �/ PLAN CHECK $ / � AUTHORIZED AGENT ��F��,e; \ $ • // J TOTAL FEE $ ('S(J 517 OWNER CR00K, FREDER2CK;4f:,.: : . .. DATE 11`3-60 . . JOB ADDRESS ••. 3163 Madeira Ave. BUILDING PERMIT NO. 13250 GENERAL CONTRACTOR Admiral-Bilt Const. VALUE $ 500.00 AP.No. 113-376-14 LOT TRACT FIRE ZONE DESCRIPTIO N OF WORK Block Wal 1 INSPECTIONS DATE I GROUP Ill TYPE 'J ZONE Rl I rground Soil U.G. Water PERMITS ISSUED L. :rground Gas --- SUBCONTRACTOR DATE NUMBER Overhead Water and Gas [ Rough Heating • t\ Q� " 'y.b� Rough Plumbing 9„ Ss . " Miscellaneous Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating, Final Plumbing Fixtures Final Gas Test Construction Pole Underground Power Rough Wiring Trenches/(40.1-Forms 11 Q Floor Systm $ Steel Reinforce Chimney Re-Rod Bond Beam i f Sheathing Frnme and Flashing I ig, In Out P._...er, brown coat T Plumbing Fixtures, Final Electric Fixtures, Final „ `\ Building, Final V, 'WILY 4t -\C-6\ rUL rrnalkit,�Al OCCUPANCY - I 11 Form 210-5M-11-59 S-B P 13250 `' FE1350 ci RECEIVED . COSTA MESA BUILDING-SAFETY DEPARTMENT NOU3 196c P. O. BOX 917 COSTA MESA. CALIFORNIA FINANCE DEPT. CITY OF COSTA MESA For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING BUILDING ADDRESS 31 b3 MAbEIRA Atie COSTA MESA CALIFORNIA For Office Use Only OWNER fkci p9/Cf LI C/LODK I RECEIPT NO. /PE5I1-s 'o MAIL RECEIVE�??�BY� I DAT; RECEIVED DATE ISSUED ADDRESS 3163 P-IAhEIRA (/ � // —3-6a /7— 3 -6' 0 TEL. BUILDING CITY Co S TA M EC A NO.1(( S)-SII- ADDRESS ARCY'�ENE NO. TEL. NEER ER COSTA MESA. CALIFORNIA OR FIRE ',���J— ` ADDRESS ^I� ZONE TYPE Xit. GROUP `1/ CONTRACTOR/- "M( IZAL- i31 LT l(BN C TR.VCTjEai APPROVED /V//,,( BDATE ADDRESS I a I V W . S S 'I' ZONING /� ZONE I NO.OP UUE OF NEW // CITY SA AfT A /j NA i� 111 I PLANS/� I BU/ILDING /���1/r�� (`/\ LIC.TNO. I 573 61 TNO. K I 1 0 0$ 6 LEGAL DESCRIPTION E . I-//• S. (tel/ -I'[ •L &..3—., SIZE NO. OF B1DGS. / V OF LOT 251 3 . )/ /r5. NOW ON LOT . A.P.NO. [ / 3'� 9� / ' A/ USE OF YARDS 'EVES EXISTING SLOG APPROVED ALLOWED SETBACK LIME FROM (CENTER LINE ST.) CENTER Op STREET REAR YARD FRONT SVT. IN. SIDE YARD I LEFT I RIGHT R.SIDE FT. ' IN. DESCRIPTION OF WORK L.SIDE FT. / IN. NEW ILII ALTERATION I II ADDITION I REAR ///���FT. / IN. REPAIR ( MOVING I II DEMOLISH I APPROVED (,(1/(/ ) DATE / /-_3`/a BUILDING NO. OF `/, �7 SIZE ROOMS STORIES EXTERIOR WALL I ROOF COVERING COVERING USE OF BUILDING AND WORK TO BE PERFORMED LE" K (' Yki39' Mg re mmy,l -r i" LOCK FEA10E- I HEREBY ACKNOWLEDGE THAT I HAVE REAL) THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT'AND AGREE TO COM. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. BUILDING CONSTRUC/TIOIN�1 VALUATION SIGNATURE OF I / ///A / �( C4--- (jfl PERMIT FEE $ y PERMITTEE (WA L\ �O/� p V v S PLAN CHECK $ \ • AUTHORIZED AGENT 11.E G TOTAL FEE S 0 OWNER CROOK, Frederick DATE 8-24-64 JOB ADDRESS 3163 Maderia BUILDING PERMIT NO. 22656 GENERAL CONTRACTOR Air Vent Alum.Awn.Co. VALUE /600.00 AP No.139-131-14 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Att.Pat•CVr• I ECTIONS Signature DATE GROUP J TYPE IVZONE R-1 St._ PERMITS ISSUED Gas SUBCONTRACTOR DATE NUMBER Water hough Com. Refrig. p Air Cond. ❑ Rough Heating Rough Plumbing Miscellaneous Prop. Swr. Line 0 House Con. 0 St. Swr. 0 Sprinkling System Construction Pole Underground 0 Power 0 Rough Wiring Trenches 0 Forms 9 Steel Reinf. 0 . Floor System Bond Beam 0 Steel Reinforce 0 Sheathing Frame and Flashing Lathing — In 0 Out 0 P'-'ter, browh coat .l 0 Air Con. ❑ Final Heating, Final Plumbing Fixtures, Final Final Gas Test Electric Fixtures, Final y/k�� Building, Final #46(-- OCCUPANCY . Form 1304-5M--3.63—S-B P _ 22856 FEE RECEIVED COSTA MESA BUILDING-SAFETY DEPARTMENT _ �A�1 JG 21 1964 P.O.BOX 317 COSTA MESA.CALIFORNIA 1 11\ANCE DEPT. \ ESA For Applicant to Fill In Completely APPLICATION FOR�PERMIT TYPE OR PRINT BUILDING o For Office Use Only BUILDING ADDRESS ,3 1 6 3 t(M D E ILA RECEIPT NO. PERMIT NO. COSTA MESA. CALIFORNIA ag3r6 RECE/Vir V DAT%'E 46- yq2E/BE D pp Op/ < �17/� CJI�a OWNER FFE/�E$,L-lCi�. cQiOo�C. ryl,� .� O�j MAILy�. ADDRESS .2/ 63 LtL /J C: / /� A ADDRESS 3 i 6 -s I A R n t I IL-A _ TEL I . FIRE _ ._ "� CITY es e. "a-. S t4 NO. I. — Z ZONE ,��GROIIyyU- ARCHITECT p TEL TEL. _ APPROVED to p� A / ORF—GINEER Lert PA>`c NO. I •� 7 ONING /` / ADL..-SS 3i // -M1L ,..rt- J t • I".17 NO.OF UEE OF NEW ref Al �v r ! e I PLANS �I' BUILDING CONTRACTOR A IL-Vea H AL— 4N_'. 66, / 3 /I LEGAL I G ADDRESS`i SDI S. 4J A N P ti. A•/Ails• DESCRIPTION 4 1 -?1 /�I/L _ CITY /`A.} Ak.QI r• A.P.NO. j ,") 7 ."" l3! ^ 1 y E 'T �T NOTE: NO EAVE OVERHANG SHALL BE LESS THAN LIC.STATNO. 11.. I i / I. NO. 7 7.1-1 3 z— zf 90"TO SIDE @REAR P.L. SIZEif EAVES EOT 7�Z / LO.S • / I NOW ON LOTSSyly ALLOWED (U.B.C.REQUIREMENT) S l ! 994. ( YARDS APPROVED YARDS APPROVED USE OF ' MAIN BUILDING ACCESSORY BUILDING / EXISTING BLDG. S. 0 W t Le N• • (FROM C/L STR T /� SETBACK LINE FROM FRONT _Q__/ FT. CENTER OP STREET REAR YARD I L. SIDE YARD I LEFT 5 I I RIGHT .J Q / R.SIDE FT. FT. DESCRIPTION OF WORK L.SIDE 21 r.r. FT. • NEW ALTERATION ADDITION X REAR /)./.FT. FT. ' DISTANCE BET. BET.MAIN ft REPAIR MOVING gEMOLI9H MAIN BLDGS. ACCESS.BLDGS. BUILDING 2 NO.OF VAR.# DATE SIZE .)2(s$C FT. ROOMS STORIES 6Aig- C.U.P.# APPROVED EXTERIOR WALL ti ROOF APPROVED our. cr / //_' u COVERING I COVERING BY E cry �('J USE OF BUILDING AND WORK TO BE PERFORMED 111 AI .> Slit.) . 24..nAiz Sa2ocAor:/ Pa As c 1..�a ;E, c-.^.� Lr. �.I y 3 3� N I HEREBY ACKNOWI%OGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE E', AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. O PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION m BUILDING CONSTRUCTION. n /� SIGNATURE OP '' _11i y oQ� /II. /I PERMIT FEE $ O PERMITTEE Q�'.� V'✓rl LYl!'... `-l"1 G ('� f C IL AUTHORIZED AGENT �. Q \' a t,A..J 6©o3 IS. TOTAL FEE $