HomeMy WebLinkAbout3133 KERRY LN - Building PermitsP40JECT ADDRESS: 7 1 3 J KERRY LN UNIT:
OWNER'SNAME: CRAIG LEVANES
ADDRESS: Srk:lE S
641-3870
ARCNIENGINEER: REG.NO.:
ADDRESS: UNIT:
PERMITTEE: CAL CASA ROOFING COMPANY (714)999-7024
ADDRESS: P O BOX 279
EL TORO CA 92630
LICENSED CONTRACTOR DECLARATION: I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section
7000) of Oivisron 3 0l the Business and Professions Code. and my license is in lull force and effect.
CITY LIC.: 056442 STATE 1409357 cuss: C 39 EXP: 08/94
Signature:
WO KERS' COMPENSATION DECLARATION: 1 hereby affirm that I have a certificate of consent to self -insure or a cenilicale of Workers'
plantationInsurance or a clarified copy thereof (Section 3800, Lab. C)
POLICY NO.: 1 1. 7 1 0 7" J 4 EXP. DATE: U 5/ 0 1/ 9 5
COMPANY: STATE FUND
❑ Certified copy is hereby furnishetl. '❑ Cenified copy is filed with the city Building Division.
Kill—Applicant:
MPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need not be completed it the permit is for one hundred S1 GO) or less).
I certify that in the performance of the work lot which this permit is issued, I shall not employ any person in any manner so as to become
subject to the WorkersCompensation Laws of California.
Date: Signature:
NOTICE: It. alter making this declaration, you should become subject to the Workers' Compensation provisions of the Labor
Code. you must forthwith Comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for
which this permit is issued (Section 3097, Civ. C).
LENDER:
ADDRESS:
OWNER BUILDER DECLARATION: I hereby allirm that I am exempt from the Contractors' State License Law for the following reason
(Section 7031.5 Business and Professional Code: Any city of County which requires a permit to construct, alter, improve, demolish, or
repair any structure, prior to its issuance. also requires the applicant for such permit to file a signed statement that he/she is licensed
pursuant to the provisions of the Contractors' Slate License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
I, 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 for sale (Section 7044, Business and Professional Code. The Contractors' Stale License Law
does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through
his or her own employees. provided that such improvements are not intended or offered lot Sale. It, however the building or
improvement is sold within one year of completion. the owner will have the burden of proving he/She did not build or improve
for the purpose of sale).
I, as owner of the properly, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business
❑ and Professions Code: The Contractors' Stale License Law does not apply to an owner of property who builds or improves (hereon
and who co tracts for such projects with a contractogs) license pursuant to the Contractors' Slate License Law). I am aware
that proof of (heir Worker's Compensation insurance should be provided to me.
❑ I am exempt under Section: 0. 8 P. C.
for this reason:
Date:
Owner:
I do hereby candy that I am aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533
25534 and that l or any future building occupant mlDwill not (circle one) need to comply who said state codes and the requirements
permit for construction or modification from the Air Duality Management District. Residential construction applications are exempt
these provisions.
and
tar a
from
Date: Applicant
I hereby certify that I have read this application and state that the above information is correct. I agree to comply van all city and county
ordinances and state laws relating to building Construction and hereby authorize representatives of this city to enter upon the above-mentionand
property for inspection purposes.
Signature:
License or Social Security e:
164146 W hde—Bmlding: Green—Code Enforcemem: Canary—Applicant; Pink—Revenue; Goldenrod—Assessor
CITY OF COSTA MESA — BUILLING FER::IT PER[: NO; s 0o8: 6
PERMIT NO: B 0631u5 PLAN CHECK NO: COVT: N _LJPI; 11
CONSTRUCTION TYPE: 5-N PERMIT TYPE: STR PURPOSE: ALT
JOB DESCRIPTION T/O REROOF W/CAL SHAKE ICB042382 t BUR SQ FT: 7,50:)
CLAIM VALUE: 7,500,00 CALC-VALUE; 7,500,00 GROUP OCC; R-3 /14-1
COMMENTS: REROOF 27SQ. F/SHAKE 5.6PSF ICBO ;1 28822 6 W/BUR 4SQ.
Z O N I N G S E T B A C K S R E Q U I R E M E N T S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING---------
FRNT: FT 1N REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT Iii
PARKING REQ: PROV: PARCEL: 14163212 ZNE; REF NO:
PLANNING NOTES>
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 M E N T S
ZONING APPROVED BY DATE:
BUILDING APPROVED BY : DATE.-
APPLICATION
ATE:APPLICATION ISSUED BY: DATE: V 4
##########ii###i5##q##%•#z- , #ir#zx # #Tt Rfkvv r: t: •% ## ###########1-., ;'s'>t'•?=1!,.
############%#######1;#i'#t_##########i:-####+;#k-t:%•i:-%t:Yxt#}k i: -#x-#!'}. aF#t`#!. t i-; }I#Y.t i'-!,
LEGALIZATION:N F E E S.0 M M A R Y STRUCTURAL SEGNENT;Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 99.00 ,75
SMIP/NON-RES
PLAN
ISSUE FEE S y
BUILDING_DIV-> PERMIT ISSUE PL roO�^ 'IQE1' TQTAL PAID DUE
TOTALS 99,75 0,00 RRFF((00J EC'l p 99,75 ,00
REVENUE DIVISION TOTALS--> COLLECTIS�•,6j/FJiii /LOVER/SHORT: 00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SNIP/TOT GRADING FLAN -CHECK
99,00,75
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T 10 N UNIT COST TOTAL COST
SFR 7500 REROOF BY VALUE RESIDENTIAL NOZONE 1,00 7,500,00
END OF FEES
0100164430-001.64431 TOT
DATE: 07/20/94 TIME: 11:19
99.75
F CONSTRUCTION AND PLANNING
APPROVALS Permit #
Date
Inspector
POOL &SPA
APPROVALS Permit #
Date
Inspector
1. Temporary Electrical Service or Pole
52. Pool & Equipment Location
2, Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.
54. Forms
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical LIFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit Undrgrnd.
8. Foundation
59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P Trap, 0 Undrgrod.
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, Rcof Drains
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical -Final
15. Rough Electrical -Conduit
66. Solar System -Final
16. Rough Electric Wiring
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMIS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit
20- Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping 0Gas 00il
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank 0 Gas 0 Oil
25. Roof Sheathing7
22
/
P�(-
74. Overhead Hydro
26. T -Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
27. Frame and Flashing
76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREY. FINAL
30, Drywall Nailing
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
79. FINAL INSPECTION
32. Electrical Power Meter -Final
33, Final Electric
34. Final Heating & Air Conditioning2t.
80. FOOD CERTIFICATE ISSUED
Notes:
/-^
35. Final Gas Pipe -Test
36. Hood or Canopy
-%�i •___
pf�IV
37. Final Factory Fireplace
`=
38. Final Plumbing
.--
.rh
39. Water Service Final
-
40. Gas Service -Final
--
41. Solar Domestic -Final
42. Backflow Preventer
43, Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
-
48. FINAL PLANNING
49, Electric Release to Edison
50. Gas Release to Southern California Gas Co:!'
51, CERTIFICATE OF OCCUPANCY
No. Date
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations
CITY a7F COSTA MESA CONSTRUCTION PERMIT
PER T NO. n
gg �
TRACT NO.
LOT NO.
UNIT NO.
A.P. # zone
Project Address - -
Applicant's Mailing Address�3 / NUd/.PPf T'
��7n
Owner's Name k..E NGG../�/v6"' Phone
Address >���
.37.7
S
Main Building: Accessory Building:
TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR
F-1CONVERSION❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
E
T
Front
Z
O
A
Rear
N
Arch/Eng. License No.
Address
fff---III
TYPE OF PERMIT GRADING FOUNDATION El STRUCTURAL
❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL
❑ 'OTHERS
PROJECT DESCRIPTION SG. FT. OCCUPANCY— PANCY
CONSTRUCTION.TYPE VALUATION $
ZONE GRADING CU.YDS. ACRES
K
Right
G
s
Left
R
Contractor's Nam Phone
Address (mailing) Pte(}-�
/ „-3
�
City License No. ([� l
LICENSED CONTRACTOR DECLARATION
Ping. Ref. # Parking Req./Provided
E
Planning Notes:
O
M
T
S.
Remarks:
I hereby affirm that I am licensed under provisions of Charter 9 (commencing
,0
/
'
�
with section 7000) of Division 3 of the Business and Professions Code, and
my license ism full J ce and effect. p�
License Class Lice e /
Date Signature
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure or a certificate
of Workers' Compensation Insurance, or a certified copy thereof (Section
3800, Lab. ) �
Policy No. Company
Certified copy is hereby furnished.
Cert e y is filed with the city By�Idi� g�Dy'vi n
ELECTRICAL FEES
PLUMBING
FEES
Automatic Washer Transformer 1115-50 KW
Construction Pole Sub. El50+ KW
Bar Sink
Showers
Backflow Preventer
Service Sink
Cooking Unit Meter ❑up to 100 amps
Backflow Irrigation
$ewer Ca p
Dishwasher Meter [Dover 100 amps
Bathtubs
Sewer Connection
Dryers ❑Gas ❑Electric Sub Panel
Clarifiers
Solar Collectors
Fan Motors❑0-iHP❑1%-8
Dat��J'>J41�r-gIr/ Applicant-��A�/J'6 �1� /
EX MPTIOE N FROM WORKERS' COMPENSATION DECLARATION
(Thissection need not be completed if the permit is for one hundred ($100) or
less).
1 certify that in the performance of the work for which this permit is issued I
shall not employ any person in any manner so as to become subject to the
Dishwasher
Solar Piping
F.A.U. Inc. Solar ❑9-15 HP ❑16-15+
Drinking Fountains
Solar Tank
Fixtures Microwave
Workers' Compensation Laws of California.
Date Signature
Floor Drains -
Swimming Pool w/Spa
Device Boxes Pole Light
NOTICE: If, after making this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith
Floor Sinks
Urinal
Outlets Range
comply 'with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Gas Service Outlets
Water Closet
Switches Sign
I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Section 3097 Civ. C.)
Lender's Name
Lender's Address
Interceptors
Water Heater -
G_arbage Disposal Standing Sections
Kitchen Sink
Water Service
,Generator ❑0-5 KW ❑5-15 KW Trash Compactor
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct, alter, improve, demolish or repair
any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he/she is licensed pursuant to the provisions of
the Contractor's License Law (Chapter 9 (commencing with Section 7000 of
Division 3 of the Business and Professions Code) or that he/she is exempt
therefrom and the basis for the alleged exemption. Any violation of Section
7031.5 by any applicant for a permit subjects the applicant to a civil
enalty of not more than five hundred dollars ($500).
I, 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-offeretl
Lavatories
Auto -Wash
P—Trap
Laundry Trays
ROOF Drains
r e
'Reinspection Fee
P $15 Issue Fee $ 3
;.DEVELOPMENT SERVICES REQUIREMENTS:
'Zoning Approved By Date
Reinspection Fee
$15
Issue Fee
$ S -
,'
MECHANICAL
FEES''
for sale (Section 7044, Business and Professional Code: The Contractor's
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of com-
pletion, the owner will have the burden of proving he/she did not build or im-
Tfor the purpose of sale).
❑ I, as owner of the property, am exclusively contracting with licensed con-
tractorsto construct the project (Section 7044, Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who
builds or improves thereon. and who contracts for such oroiects with a con-
tractor(s) license pursuant to me Contractor's License Law). I am aware that?{
proof of their Worker's Compensation insurance should be provided to me.
❑ I am exempt under Section B. & P. C. for this reason
Building Approved By Date_:.
Jap/ -WE/ --
Application Issued By A not
Boiler
Hood Of Type ❑
yp
Canopy Type II ❑
'- SUMMARY OF FEES
BUILDING PERMIT $ SMIP $
- PLAN CHECK $ PERMIT
PLUMBING $-�_V ISSUANCE $
'
PLAN CHECK 25% ENERGY P.C. $
$
ELECTRICAL $ GRADING $
- PLAN CHECK 50% $ MICROFILM $
" MECHANICAL $ TOTAL FEE $ cy " c/
�
PLAN CHECK 25% $
Duct - Under Ground
Duct -Structural
Refrigeration System
❑0-100,000 BTU 0100,000 BTUFn
l
Duct - Ventilating
E%haUSt System ❑ Multiple ❑
System Repair/Alteration
Firepl/Fact. Bit. ICBO #
Fire Dampers
-
Date Owner
hereby certify that I have read this application and state that the above
Information is correct. I agree to comply with all city and county ordinances
and state laws relating to building ristruction, and hereby authorize repre-
sentatives of this city to enter �iop n the above-mentioned Property for
Heating System & Ducting
00-100,000 BTU 1_1100,000BT
Registers
inspection purp G/,r��
Reinspection Fee
$15
Issue Fee
$ 3
signature Date__
Drivers' License or SS_VL �
nn ttttA nncc -s-
ur �7•`=_-1 n r
i,J;, 4y i.25'00Q 0125 y f„f t J,013
< DATE: �_
T:I iL ;. �5"'sl i
0865-46, rev. 5/88 White - Building; Canary - Applicant; Pink - Accounting;
Goldenrod - Assessor033/0189
I 1 l
CONSTRUCTION AND PLANNING
APPROVALS Permit #-
Date
Inspector
POOL & SPA
APPROVALS Permit #
Date
Inspector
1. Temporary Electrical Service or Pole
-
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3 -Electrical Conduit Utility-Undrgrnd.
54. Forms
4.,Electrical Conduit-Undrgrnd.
55. Electrical Bonding
5. Steel,Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical LIFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
8., Foundation
59. Gas Pipe, 0 Undrgrnd., Test
. 9..Water Pipe-Undrgrnd.
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
66. Solar System -Final
16; Rough Electric Wiring
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
i8. Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
'
22. Ducts, Ventilating
71. Product Piping 0Gas ❑Oil
23, Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank 0 Gas 0 Oil
25. Roof Sheathing - -. _. -
..
74. Overhead Hydro -
26. T -Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
27. Frame and Flashing
76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREV. FINAL
30. Drywall Nailing
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
79. FINAL INSPECTION
32. Electrical Power Meter -Final
80. FOOD CERTIFICATE ISSUED
33. Final Electric
Note,.3 t4Y?
34. Final Heating & Air Conditioning
(-get PEIP-m,T libFP12ED 4S PEa ZP3
35. Final Gas Pipe -Test
Vire.• L £ o
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service -Final
40. Gas Service -Final
41. Solar Domestic -Final
42. Backflow Preventer
t
43. Backflow Irrigation
44. ,Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations '
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
; )
50. Gas Release to Southern California Gas Cc
51. CERTIFICATE OF OCCUPANCY
No,_ Date
"'
OWNER HARBOR HALL OF FAME HOISS INC. DATE [NOV 3 0 1962
JOB ADDRESS 3133 Kerry Lane BUILDING PERMIT NO. 1830_5
GENERAL CONTRACTOR Lifetime Residential Bldg. Corp. VALUE $ 17,0%5.00
AP No. LOT 55 TRACT 4356 FIRE ZONE DESCRIPTION OF WORK Res Att.Gar
INSPECTIONS
Signature
DATE
GROUP M j TYPE p ZONE R-1
Soil
VWYZ
/1/
SUBCONTRACTOR
PERMITS
ISSUED
Gas
DATE
NUMBER
Water
_
_ _ _
- - -
L-(�
_fir
/�` �i
Rough Com. Refrig. ❑ Air Cond. ❑
Rough Heating
_
— S- �.
Rough Plumbing
Miscellaneous!
Prot). Swr. Line House Con. ❑ St. Swr. ❑
_
_7-G-
Sprinkling System
onstmetion Pole
Underground ❑ Power ❑
'Frenches Forms V Steel em. ❑
Floor System
72 -r9 -di
Bond Beam ❑ Steel Reinforce ❑
Sheathing
Frame and Plashing
3- 6
Lathing — Ih Out 2�
Plaster, brown coat
Refrig. ❑ Air Cond. ❑ -Final
Heating, Final
Plumbing Fixtures, Final
Final Gas Test d�
-(-
S
ElectricFixtures, Final
r
Building, Final
�f�liQ
OCCUPANCY
FORM uua->m - 7.61 1mgnS
18305
COSTA MESA BUILDING -SAFETY DEPARTMENT
P. O. BOX 917 COSTA MESA. CALIFORNIA
a
Lot 55, Trac1��'3{ ' REGMED
!e �,�L MOV 30196L21 '
For Applicant to Fill In Completely
TYPE OR PRINT
APPLICATION FO ¢Mi E DEPT.
BUILDING OF COSTA MES
BUILDING 3 3 -1,
ADDRESS �1 er✓>,
For Office Use Only
COSTA MESA. CALIFORNIA
Harbor Hall of Fame Homes Inc.
RECEIPT NO. PE l
OWNER
.7
MAIL
RECEI D BV OA R C81VggD DATE ISSUED
ADDRESS P.O. Box 2066
�' c�7175Y1 ,10.1 a ulk5
Santa Ana TE 9..2204
BUILDING
CITY No .1
ADDRESS
ARCHITECT Jamison TEL.5r(�4_0040
COSTA MESA. CALIFORNIA
OR ENGINEER NO.
225 "DN St., Tustin
FIRE
ADDRESS
ZONE TYPE GROU
Lifetime Residential Bldg Cor,APPROVED
CONTRACTOR
BY DATE
2131 So. Artesia St.
ZONING
ADDRESS
Santa Ana
ZONE
USE
ONGEWLI
CITY
I PLANS >/
BUI
208676 TEL KI 9.2204
LEGAL
LIC.STATNO.
DESCRIPTION �`S Tom. 43 S7o
SIZE
6000/
I NO. OF BLOBS. 0
LOT
NOW ON LOT
A. P. NO.
USE OF -
YARDS EVES
EXISTING BLDG
APPROVED ALLOWED
SETBACK LINE FROM[O 1 pll 5o
5
ICENTER LINE ST.)
.INTER OF STREET REAR YARD JTZ
FRONT S� FT. IN.
SIDE YARD ILEFT 5/
(RIGHT 51
R.SIDE FT. �— IN.
DESCRIPTION OF WORK
L. SIDE FT. IN.
NEW Ix II ALTERATION I II ADDITION I
REAR 3 L1 L5 FT. IN,
REPAIR I I MOVING I DEMOLISH I
APPROVED /� DATE O -a�-
ilk
NO. OF lO
BUILDING .11.9An 14 1
S ZE ROOMS STORIES
IROOFShake
COVERINGEORY14LIas+ter
COVERING
USE OF B ILD( G WORK j BE PERFORMED
Tam9i
Sing a y residence
dy
I HEREBY ACKNOWLEDGE T T I HAVE READ THIS APPLICATION
THE AMOUNT SHOWN ER VALUATION 18 FOR THE
AND STATE THAT THE ABO IS CO RECT AND AGREE TO COM-
PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY M. CEB N ET LAWS GULATING
VALUATION
/V
BUILDING coxeTS, N.
SIGNATURE 6
PERMIT FEE $ K•/J(
PLAN CHECK $ X y Q
4 '16{1
PERMITTE
$ /
AUTHORIZED AGENT
�'J/
/ '/ G ��
TOTAL FEE