HomeMy WebLinkAbout3081 MADISON AVE - Building Permits OWNER innrr/ i.nniwnn DATE (-24-W
JOB ADDRESS 3081 Macason Ave. BUILDING PERMIT NO. 28889
GENERAL CONTRACTOR Custom Craft Masonry DESCRIPTION of WORK Screen BLOCK Wall
No.141-595-03 LOT TRACT FIRE ZONE VALUE $ 350.00
ECTIONS Signature Date GROUP J TYPE III ZONE R1
sol_ PERMITS ISSUED
GAS SUBCONTRACTOR Date
Number I Signature
_WATER Plumbing
ROUGH PLUMBING
PROP. SWR. LINE ❑ HOUSE CON.
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND ❑ POWER ❑
ROUGH WIRING Heating and Vent.
TRENCHES 10 FORMS STEEL REINF. /0/9
7-S S-Lr
FLOOR SYSTEM
BOND BEAM n STEEL REINFORCE n
SHEATHING
FRAME AND FLASHING
LATHING - IN H OUT n
PLASTER, BROWN COAT
ST TURAL, FINAL Electric
AL .G, VENT., REFRIG. AND A.C., FINAL
PLUMBING. FINAL AND GAS TEST •
ELECTRIC, FINAL+.'�"'IJ+' ,{^ ��� �((� ''•-- (/y, (� C�
BUILDING, FINAL f1A 0fei ,pl;()'VL W� ma �l lhl' �_t 119
28889
• - a 24-68c sn00,1851 d*****3.00
, COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 317 COSTA MESA.CALIFORNIA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
/cT� //�J / �Mr i For Office Use Only
ADD ESS 50" / hf,4t s L/'v-•f uL / _
C RECEIPT NO.
COSTA MESA.��. CALIFORNIA D •x•. •
OWNER �/"(^^c�vN6s /��'c'-a-�/^- ,.T RECH 2pt.JE R`/HI p0 q.�T 9I "E•61
ADDRESS �C' / PlIt �/_'. - ADOREBUILDS
3 6 A b/
FIRE
1�. ,e NO.5/8/a ZONE TYPE I__ GROUP I
CITU ;
APPROVED EV
ARCHITECT TEL. BY E'/ i
OR ENGINEER NO.
1� I Ile I(ING n�/�//�[I✓., ,I j('//,1n
ADDRESS /J ��` zo g I NO.no
'v I BYILDFNO W�GX/' 'fes" (U
CONTRACTO�pq/�')GLN""�y/r�'[y/1,� INT n "� 7-:ie
/,/�'...�!((rrr' /1l/'
ADDRESS.iTy 2) . #�J�'�`,!`'!� DESCRIPTION -�!// f 1R / ( ' ✓\ T lel 17
CITY �I�CI W p�1 (�J/fryyli/'-- A.P.NO. f t// - '7 S� el q J
GG77 ^^ 6 r� /(� NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
LIC.rNO.:57,-SO. NO. SW/n (� SO" TO SIDE B REAR P.L.
EAVES
SIZE ! Y. / NO.OF BLOCS. ALLOWED (U.B.C.REQUIREMENT)
OF LOT gat n IA�J I NOW ON LOT
jY YARDS APPROVED YARDS APPROVED
USE OF MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG.
1 FROM C/L STREET) /�
SETBACK LINE FROM FRONT FT. • /iG/ FT.
CENTER OF STREET REAR YARD
SIDE YARD LEFT I RIGHT R.SIDE FT. AFF.--?
DESCRIPTION OF WORK L.SIDE FT. - Cm
NEW _ ALTERATION _ ADDITION X REAR FT. C eztram7,41
DISTANCE BET. BET.MAIN B
REPAIR MOVING DEMOLISH MAIN BLDGS. ACCESS.BLDGS.
VAR.SC • DATE
BUILDING NO.OF
SIZE ROOMS STORIES C.U.P.* APPROVED
EXTERIOR WALL I ROOF APPROVHD / A,f ATE ,j
q/e1EOVERNG COVERING
Ur ABE fiRp
A._et-ii G (
•
N
SO.FT. G
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 CON. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O
PLY WITH ALL CITY ORDINANCES AND STATE WS EGULATING VALUATION
BUILDING CONST RUCCTTIS/ISI o h
SIGNATURE 0F1// riG dO PERMIT FEE $3 '—' •D
PERMITTEP /'` O•e•`({ G
//���2 $ L C o
AUTHORIZED A r. "� E
TOTAL FEE $
OWNER TRAPP, Mr. & Mrs. Charles DATE 5-21-63
JOB ADDRESS 3081 Madison Ave. BUILDING PERMIT NO. 195112
GENERAL CONTRACTOR Southern Cali eenhou&ea VALUE $ 500.90
On No. LOT 21 TRACT 4607 FIRE ZONE DESCRIPTION OF WORK Pet_Grpaphnntse
?ECTIONS Signature DATE GROUP J TYPE V ZONE R-1
Soil PERMITS ISSUED
Gas SUBCONTRACTOR DATE I NUMBER
Water
Rough Com. Refrig. 0 Air Cond. 0 •
Rough Heating
Rough Plumbing
Miscellaneous
Prop. Swr. Line O House Con. 0 St. Swr. 0
Sprinkling System
Construction Pole
Underground Power
Rough Wiring 'i'7,r fer/'lrCJatlient, .leu/. c's• G-,4L6,� .d oo 7 —
Trenches 0 Forms 0 Steel Reinf. 0 •
Floor System
Bond Beam ❑ Steel Reinforce 0
Sheathing
Frame and Flashing
Lathing — In 0 Out 0 _
>x " `,r, brown coat
Mpg. 0 Air Con. ❑ Final
Heating, Final
Plumbing Fixtures, Final
Final Gas Test
Electric Fixtures, Final -/7-65 ii/r/h \
Building, Final /2*-{,3 ,t 44�'
OCCUPANCY
Form BU4-5M-3-63--S-B P 1 0SL'P
19542 ,FEE RECEIVED
;COSTA MESA BUILDING-SAFETY DEPARTMENT . - Wec-4V1.Z I1 ICIi03
P.O.BOX 217 COSTA MESA.CALIFORNIA FINANCE DEPT.
(`1 v nF nne`T
For Applicant to Fill In Completely APPLICATION FOR PERMRa MESA
TYPE OR PRINT BUILDING
For Office Use Only
BUILDING
ADDRESS 30 8 / Ala
s�,CJ iO A ✓e
RECEIPT NO. PERMIT NO.
COSTA MESA, CALIFORNIA
RECBI[y�ED BY DATE 0/-- Z3 i Zl 43
OWNER AIt iI.///MS /-H?.44r�_ .- _ !a. �f�^f
MAIL K//1� BUILDING ?D O/ 777 oO-�.
ADDRESS��// g/o,5'/ M,-�/ (n •-/ Aye ADORE88 Ol o / /�/ ///
CITY (-O(�C P def/' NO.
_'oJ,/ ZONE TYPE f CROUP �/ /
APPROVED ��aa--�//
ARCHITECT ''// TEL. BY DATEv/ V-
ORENGINEER �/�-/TG//S(� NQ. Ar G4/tz '
ONING
ADDRESS 9/7o //L L las rt•enaS A2 10 NO.NO; •� UB60F NEW
/// //n r:.9 ,'NRyt. ( I PLAN; (./ I BDILDIND
CONTRACTOR JO e-/ e/1f1 ..e.--(7,7- In QPP//%J TY/F�= l .
O SCRIPI'ION 1 et • / -t� l{(6 �/]
a /
ADDRESS 12 I g4y - �j/ifPi>trol� ,Ir '^ � /-
CITY 2 - rrn'r4'a cQ A A.P.NO. c rs.. . � /�--�"
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
STALIC.TE TEL.NO. /79 -/1Z-J3/ NO, AT oar'/ 3EAVES
3C:"TO$IDEA REAR P.L.
SIZE / ✓ 1 NO.or BLOBS. ALLOWED (U.B.C.REQUIREMENT)
OF LOT !p .2..._„.K / 0 0 I NOW ON LOT /
YARDS APPROVED YARDS APPROVED
USE OF MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG. /../1.7,,g1 F 1F C:C4�y C
- (FROM C/L STREET) //� dal
SETBACK LINE FROM FRONT FT. / \ F . /h E.
CENTER OF STREET REAR TARP / 1!
SIDE YARD LEFT beI RIGHT a 9j R.SIDE FT. FT.
DESCRIPTION OF WORK L.SIDE FT. 3.-°FT.
NEW i ALTERATION ADDITION
REAR FT. 3 FT.
DISTANCE BET. BET.MAIN&
REPAIR MOVING DEMOLISH MAIN BLDG$. ACCESS.BLOCS.
BUILDING NO.OF VAR.# DATE
SIZE I.
X ROOMS 1 STORIES C.U.P.# APPROVED
EXTERIOR WALLROOF APPROV ✓
COVERING I COVERING BY VVVV���f....�� ... DATE Jr C /- IC_�_
USE OF BUILDING AND WORK TO BR PERFORMED h /'I11�
5X 57 leett;40,n' / /- ,At41JC �!!� /l
Pf1�( 4' 1 a E.#1,4J h�-f A� _, keC-“-V.G/ B
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIONTHE AMOUNT SHOWN UNDER VALUATION IS FOR THE S
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
BUILDING CONSTRUCTION. PPERNMIGTHFEEGE
SGRNMTUREO��/,,/- 1e-rn (-;/7/n/rr1/I S, oo �—
m
A/S $ ,c6 MK $$ Yr _o
AUTHORIZED AGENT %atZa4tCtK c
TOTAL FEE $ ��
OWNER HEDRICK, Robert W. DATE 70_1-78
JOB ADDRESS 3081 Madison Avenue BUILDING PERMIT NO. 47R07
GENERAL CONTRACTOR R. B. Const. DESCRIPTION of WORK Arid Footage to Dining Area
� "oro o, 141-595-03 LOT TRACT FIRE ZONE VALUE $920.00 •
'I'Iiz'f'ECTIONS Signature Date TYPE v GROUP T ZONE R-1
SIOIL`
SUBCONTRACTOR PERMITS ISSUED
GAS
Date I Number I Signature
(xWATER Plumbing
'ROUGH PLUMBING
\ PROP. SWR. LINE Q House CON. fl
4SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING •
TEMPORARY SERVICE OR POLE
UNDERGROUND 0 POWER 0
ROUGH WIRING 9) fiY7}'7(, Heating and Vent. . .
TRENCHES 0 FORMS U STEEL REINF. n p{_, (pr..5-iv
-
FLOOR SYSTEM
•
BOND BEAM in STEEL REINFORCE n41 6
SHEATHING I ala' p _7 4
FRAME AND FLASHING /' It in:T(t
LATHING — IN CZ, OUT IG1 4,12 ,0'/4C,76
PI ASTER, BROWN COAT "145 41Qj14C
:TUBAL, FINAL Eke rIC
H...IING, VENT., REFRIG. AND A,C., FINAL R. $. C lo-11.74 if/24S.e
PLUMBING. FINAL AND GAS TEST n
ELECTRIC, FINAL fit f//'(`•7[
BUILDING, FINAL it-J /e//'/G
. ' 42807QCT -1-76pr`QQ 103 ' *L 't1C.5C
r COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
API I AT ON FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely — Use Ink Only
/'pp'� ��/ Q REC I :is �/ DATE RECEIVED DAp ISS E
9ADILRDIrJG •,,,0
?S// �� 7 o,,%//S Q�'� vC� .✓ /�—r—/G
COgze. A.P. Ne M
NG p
MAIL �dES///li4Q/SaztJ ADDRESS�/ / %' 9 1lr
ADDRESS 7 �) �,s
CITY lvs7 �1G919 NE01:75.7.,
7j7(/Y/� TR AC. �10'/ LOT...9/ BLOCK
CONSTRUCTION NEW ADD ALTER REPAIR MOVING DEMOLISH
LENDER
BRANCH �/7 �1 //
WNE LJA /C jk
ADDRESS a / _ 1 VALUE in--
OR
'C
ARCHITECT TEL. US •�L27 /�/(/�J�J $ —
OR ENGINEER NO ''y/Ax///J
FIRE
ADDRESS ZONE PE GROUrP /
�� �� APPROVE / / / • 7G
CONTRACTOR �D�o7/.r!/GI !d�(/ BY ( DATE 7/
ADDRESS I TJ /je, Y L3200/57. / Z /
• I NO.OF USE OF N ,/ '�/ poo.
TEPLANS BUILDING /
CITY , NO. Ye.' i . 2
FI STATE C/ CITY J YARDS APPROVED YARDS APPROVED
LIC. NO. j3 j y2 9 LIC. NO/��J 7J MAIN BUI DING ACCESSORY BUILD1.1
IQ SIZE NO.OF BLOCS. (FROM Cn/L EE/T)
A. OF LOT NOW ON LOT FRONT,f L FT.
Q USE OF
EXISTING BLDG. R.SIDE -4T. FT.
COtit 1
F5 Separate permits are required for L.SIDE t / FT. FT.
electric, plumbing and heating work. //jj i I
dREAR .-.l0F FT.
t.. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& '
MAIN BLDGS. ACCESS.BLDGS.
, 17D //,J /O / •
/ /is///l/l VAR.ta‘
C.U.P. yDATE
APPROVED VEDQ 7 /J
APPROVE / V_
3.'
//OO !a �/ SY C Lu DATE O --I- 7C
CC
IR
O I hereby acknowledge that I have read this application and state N
N
C that the above Information is correct and agree to comply with
L all laws regulating building construction, and I shall not employ a,
Z any person in violation of the workman's compensation laws of /// ////// 2
�_ ,the State of California. / (`' m
3 I hereby certify that I am properly licensed as a contractor under T/ v SO. FT. NI
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABUSHING A PERMIT FEE ONLY: •7,
am exempt from the provisions of the State of California Business 'o
and Professions Code, Division 3,Chapter 9. VALUATION PERMIT FEE $ 16 ?---- N
m
� n
Signature of. /,�tt //�yy�,�yy / 9267 JCHECK bLLPermittee $ TAX s 51)Authorized gent J� U
_ _, . c TOTAL PAID s /II f
OWNER HEDRICKS, Mr. ' DATE 11-4-76
JOB ADDRESS 3081 Madison Avenue BUILDING PERMIT NO. 47979
•GENERAL CONTRACTOR R. B. Const. Co. DESCRIPTION of WORK Pori° Co+rer
N4f9 ). 41-595-03 LOT TRACT FIRE ZONE VALUE S bon nn
GIECTIONS Signature Date TYPE V GROUP J - ZONE R-1
sou • ' SUBCONTRACTOR PERMITS ISSUED
GAS Date I Number Signature
WATER Plumbing
• 4 ROUGH PLUMBING I I I
PROP. SWR. LINE C0 HOUSE CON. Li
SPRINKLING SYSTEM
MISCELLANEOUS
\ROUGH HEATING AND AIR CONDITIONING •
_ .
TEMPORARY SERVICE OR POLE
UNDERGROUND 0 POWER 0
ROUGH WIRINGHeating and Vent.
R
TENCHES FORMS STEEL REINF. I C (t.-1.-4--
FLOOR SYSTEM
BOND BEAM 0 *STEEL REINFORCE I]
SHEATHING
FRAME AND FLASHING''
fl
LATHING - IN I I OUT fl
P' 'TER, BROWN COAT
TURAL, FINAL Electric
HEATING. VENT.. REFRIG. AND A.C., FINAL
PLUMBING, FINAL AND GAS TEST n
ELECTRIC, FINAL �J� - .
BUILDING, FINAL Y//" ) 4",'&7c. _
n 42979 .I':, .• .
• COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely — Use Ink Only
�• > RECEI DATE RECEIVED IS Crf�/
BU
LDI NG
ADIDRESS �OC///jff/,e9/•SO.f.. Q{�� s- I//6
OWNER/4� ��0�'�� A.P.NO. Y/�.�/J t_(/ PERMIT NO.
MAI 4c.) BUILDING
ADDRESS gay/,' q '/SG' ADDRESS 3O4F/ 0,1 79s�/ /9(/�-
_� TEL`-- TRACT/j'7�! LOT7/ BLOCK
CITY 61:31...5%;57 ���...T/Jt NO✓,./��F7��
CONSTRUCTION NEW ADD ALTER REPAIR MOVING DEMOI ISH
LENDER K
BRANCH
OWNER", � Pe
n/r�'rfe„4S'
ADDRESS �� an VALUE / /,
ARCHITECT TEL. USE /e�7 $ (Grl7!
OR ENGINEER NO.
FIRE r`6..
ADDRESS ". ,. ZONE TYPE TC GROUP {I
�/y� ))�� APPROVED , / 7/
CONTRACTOR // ,,, ra,e%y��e/i/ ci� BY /7,44
� RJ DATE /� `IO
ADDRESS /t. O j�!ztWya!.s.020::::.lf! 20 NO.OF �` USE OF N
TEL. �p /pit/� PLANS c BUILDING qL -7/�
• CITY c .t/J•= NOS-/•1/50/ ( \ cc,
1 /7.(.1.� ,....wet.„
STATE CITY YARDS APPROVED YARDS APPROVED
g", • 'LIC.NO. . y �, ,LIC.NO}//j'77 MAIN BUIL:0 NG - .ACCESSORY.BUILDING
(fy S
SIZE NO.OF BLOC (FROM C/LSytyE ET) '
n, OF LOT NOW ON LOT FRONT Q Fd. FT.
Q •USE OF •
EXISTING BLDG.'. •
• R.SIDE CR''T. FT.
FSeparate permits are required for ,. R,,,"•, L•SIDE ST. "'% FTr
electric,plumbing and heating work. ,
D - REAR / - FT. _
I-, USE OF BUILDING AND WORK TO BE PERFORMED
F DISTANCE BET. • BET.MAIN&
0 - MAIN BLDGS. ACCESS-BLDGS. -
VAR.#' DATE
:11
/L��CJ� C.U.P.qW /� ^ /� APPROVED -,./-/
C _flAPYPROVEW (v/ / 1.V / DATE i/—�^/_
C4 t l/l/�'\ .
IR •
0 I hereby acknowledge that I have read this application and state
N
a that the above information Is correct and agree to comply with • - r
d all laws regulating building construction, and I shall not employ '' m
Z any person in violation of the workmen's compensation laws of m
TTT. the State of California.
I hereby certify that I am properly licensed as a contractor under SQ. FT. N
the State of California Business and Professions Coda, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR 00
Chapter 9, and that such licenses are in full force and effect,or I 'THE PURPOSE OF ESTABLISHING A PERMIT F ONLY:
am exempt from the provisions of the State of California Business 0
VALUATION PERMIT FEE $ OB
and Professions Code, Division 3,Chapter 9. th
06.0
PLAN CHECK S l m
^I
Signature of _ C f 0
Permittee a .e S �t/ TAX $ c/0 2
s U
U
Authorized •gent TOTAL PAID 5 / co
I!
,to-atuci du, &,,,o{r4 .
�eee� 3
34 %1 c/ coc..o C oye Lie/
.nte-a# ilo
s
re-cfra/ 0-4 al-, 4-e---a.tc.a.-.;excl -64 .-
o-a-c2-e::0 zVe_0._ eLe.:e.lrety, 04zA-ig
LPLA- abc_ A-ittexalt- ez/ 411, 1-ea/ -14:aan-- 9 a-ec,/ alrect-Pic
„_-ae--.9-42-0/ (`-e-z4-61-1---t, ,01-e.erf 7Xce
I 4.2-o-ecze;./ oe_
yi-eetyaedq z4iimaere
CzGz' Gctt�o Baa �,.� a��, fLio�� 3 a4 �' . c/ -eh. •
1 . �_at. RECEI E
i 1 17048 P.4AY 17 1961
COSTA MESA BUILDING-SAFETY DEPARTMENT (: FINANCE DEPT.
P. O. BOX 917 COSTA MESA. CALIFORNIA
CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT ��// BUILDING
BUDRES
ILDIN O e/ /4 cvd,s, � 4rt-
COSTA MESA. CALIFORNIA For Office Use Only
RECEIPT NO. I I1H048
OWNER Occidental Loan Company lu�ro
MAIL
RECEIVED BY DATE ECEIVED DATE ISSUED
ADDRESS 2901 Benedict CanyonL. �TppArtve p�, 6p „n..Y 31 X962
CITY Beverly Hills NO. Onin ` ADD ESS UILDING 3001 '1'7adison Avenue
ARCHITECT TEL. COSTA MESA. CALIFORNIA
OR ENGINEER — NO.
ADDRESS RIRE CP(
0,/1
OZONE TYPE `/ '1AGROUP
CONTRACTORAlfr on W' h), APPROVED
A A el SO BY DATE
ADDRESS 2901 Benedict Canyon Dr. ZONING Q�
CITY Beverly Hills , California Z°"jQ_I IPO. 2 I BUILDINGw/£;./7,,/`(A•
nX.r f.a-I .
STATE TEL 141355 NO. CR.-6-8940 , DESCRIPTION Lot # 21 TR-4607
61ZELOT 6 r2)y(�f�iNO. OF SLOGS.
OF �0 I NOW ON LOT O p p NO
USE OF YARDS EVES
EXISTING BLD -- APPROVED ALLOWED
SETBACK LINE FROM (CENTER LINE ST.) L/
CENTER OF STREIIT 51 1 REAR YARD 271 FRONT -1 / FT. — IN.
SIDE YARD I LEFT 5' I RIGHT 51 R.SIDE S FT. IN.
DESCRIPTION OF WORK L.SIDE 3 FT. —
IN,
NEW I XII ALTERATION I II ADDITION I REAR Z 7 FT. -3 IN.
REPAIR I II MOVING I II DEMOLISH I SYPROVED �, /v�8, DATE 57:0 t-
SBZEILDING 52X49 ROOMS 7 STORIES 1 `��
EXTERIOR Wbl__ I ROOF Wand 1:2n MC
COVERING CCO COVERING
USE OF BUILDING AND WORK TQ BE PERFORMED
1 - Pam. Res. w/attached Gar.
,/ /73e
2 "�7�J \�j�
1.1 e/ 66' PcYt)i eb c A'1p�� -A n
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIO THE AMOUNT SHOWN UNDER VALUATJIJN IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AN AGREE TO CO PURPOSE OF ESTABLISHING A PE MIT PEE ONLY.
PLY WITH ALLCI ORDINANCES AND STAT LAWS ULA G
BUILDING CON UCTION. VALUATION
SIGNATUR �� //// e� 1' PERMIT FEE $ 41/4—
a/,
PERMITTE (((///lll///���,,, $ 21 ,02Y.00 PLAN CHECK $ L2C'.3 e) 4
s
AUTHORIZED A NT el G
TOTAL FEE 4