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Home My WebLink About226 KNOX PL - Building Permits • CITY OF COSTA MESA 4440,111e qe BUILDING DIVISION }:j ; $ DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4, /1'y .6Lf° PERMIT 4kkvirkvama,1.4* M03-00599 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 226 KNOX PL Status: ISSUED Suite No A - Applied: 11/13/2003 Issued: 11/13/2003 Vicinity: Parcel Number: 42533412 _ ISSUED BY: t Applicant: JOE ELLIS - _ Address: 3801 LENAWEE AVE Phone:, (310)253-5229 , CULVER CITY,CA Zip: 90232 Owner: , MORIANA, ROCCO A TR ' ` Address: 22766 BRANDYWINE DR Phone: ' CALABASAS,'CA Zip: 91302-5735 - Contractor: ORANGE COUNTY SERVICES INC DBA GEORGE BRAZIL PLU Address: 3801 LENAWEE AVE , -Phone: (310)253-5229 CULVER CITY,CA' ' ' Zip: 90232 ' License:679898 - - _ SCOPE OF PERMIT REPLACE 35,000 BTU WALL HEATER AND VENT MECHANICAL TO INCLUDE: INST/REP RECESS WALL HEATER.- - - - FEE SUMMARY '_Quantity - -' - 4 Quantity ISSUE FEE $23.50 . - Repair/Alt Absorbtion Unit ' $0.00 0, Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 -0 Inst FAU>100 k BTU $0.00 0 Ventillation System Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler Inst/Rep.Recess Wall Htr $14.80 1 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 _ _ Domestic Incinerator - Refrig Sys>100 k BTU $0.00 0 - Compressors/Absorption Systems , , . , Gas Piping $0.00 0 ' . Up to 3 hp-/A 00 k BTU $0.00 -0,- Factory Fireplace - $0.00 0 >3 To 15 hp/.500 k BTU.. / $0.00 0 Hood w/Meth Exhaust ' " $0.00"'0 ' • ' ' 15 To 30 hp/1,000PkBTU ,/, $0.00 - 0 VAV Box ' $0.00 0 30 To 50 hp/1,750 k BTU � , $0.00 0 Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU , $0.00 0 Appliance $0.00 0 Boilers - ' Fire Dampers $0.00 0 Up to 3 hp - ' ' Smoke Dampers $0.00 0 3 To 15 hp / $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp ' - / $0.00 0 Air Handlers< 10000cfm , $0.00 '0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 . Over 50 hp .. $0.00 0 Floor Furnace ' $0.00 0 Other Mechanical Fee - Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee / - ' $0.00 Reinspection Fee $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS Cn • n WORKERS'COMPENSATION DECLARATION: ' I hereby affirm under penalty of perjury one of the following declarations: O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ( -I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. —My workers'co nation Ins nceyarder�and policylinumber are: �/ �i /� Carnet: {J!(We 1-Q/L/✓ (Policy Number: /t/! 27-03 _v 3 (This section need not be competed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the w• f.' •ich p=. it is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Cajoga and I - ould •ecome subject to the workers'compensation provisions of Section 3700 of the Labor C a,I shall forthwith comply with these provi _ /7 Q Applicant Signature: � 7 (Date: • /Ll`6 WARNING:FAILURE TO SECURE WO-)-• 'COMPENSATION•r. ERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN A•, ITION TO THE COST OF'•MPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I herebyaffirm.that 1 am licensed un cproyi'�sAjofcps...oSnep r 9(commencing with Section 7000)of Division 3 of the Business apil Pro(5ssioo3Code,and my license is in full force and effect LIC,it • • /C fCr��` (Class- - �. a_CJ 'Contractors Signature: (—Date:— /I-/o -63 CONSTRUCTION LENDING AGE CV: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions 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 or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or 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(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or 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 completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). O As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a..ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I a• ee not to occupy or allow occupancy of any building authorized by this permit until final inspection. S en..,. i A er.) ///3 Date0 (Amer Authorize.Applicant • _ C'Date-i CODE t INSPECTION TYPE PAI$ - MAO CODE• INSPECTION TYPg \ PM MALE I'I 1616 Fixed System Final Fire Prevention 206 Final Mechanical '03 B 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PER N TRACT NO. LOT NO. UNIT NO. CITY OF COS•TA MESA_CONSTRUCTION_PERMIT A.P.# Zone •Project Address � _ B ,,� _ - l ys 7 S - _ - ._ t J_ �_� O� I S Main Building: - Accessory Building: Applicant's Marling Address __ TYPE OF CONSTRUCTION U NEW H.ADD' ❑ ALTERATION ❑ REPAIR, •E - - - - - Z �T .//iJ�U ; - • 11 CONVERSION. ❑ DEMOLISH ❑ OTHER - T Front - • • - 0 Owner's;Name;_ L.. C- �� Phone • `DESCRIPTION OF WORK/USE OF BLDG. B Rear. - - • . - N Address •"""V f' - • Arch/Eng. - - License No. TYPE OF PERMIT ' '❑ GRADING LI FOUNDATION ❑ STRUCTURAL . • C. Right_ • . , ._ G Address C TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL - S • Left - . ' . .. r ❑ OTHER • R Contractor's Name �/�/r! rJ�a'�i Phone�U �3�1� I Ping: Ref.4' - Parking Req./Provided ..: E / PROJECT DESCRIPTION SQ. FT. OCCUPANCY - O Address lmailing) ��n ' any' ��ib �� Planning Notes: M • CONSTRUCTION TYPE ' •VALUATION$- I • T City-License No. -_./Z_20„3- ZONE - GRADING CU.YDS. •• ACRES l - • S. LICENSED CONTRACTOR DECLARATION ' - - • Lhereoy affirm that-I am licensed under provisions of Charter 9 (commencing Remarks: : • _ • ' • with section 7000) of Division 3 of the Business and Professions Code, and . - • - — _ - my license-is in full force and effect. In i ' ELECTRICAL FEES License Class - r - '3 LI : 'Rag./O /-�`(- j� r PLUMBING • FEES Automatic Washer Transformer 0 15-50 KW •Il . . Date -2" Signature / ' WORKERS' COMPENSATION DEC -!- '%!1✓� - - Construction.Pole •Sub: 0 50+KW I hereby affirm that I have a certificate o consent to self- sure or a certificate Bar Sink Showers s' Workers' Compensation Insurance, or a certified copy-thereof (Section - Cooking Unit • , Meter ❑up to 100 amps `•00 Lab. C.) -, - - - Backflow Preventer .. ,Service Sink . . - . - ..-_ _ - _.. _ -✓ol icy No. • • Company - Backflow Irrigation Sewer Cap •' Dishwasher • Meter Dover 100 amps eCertified copy Is hereby furnished. - Dryers ❑Gas ❑Electric Sub Panel Certified copy is filed with the city Building Division. •. Bathtubs Sewer Connection - - Date • Applicant - • Fan - Motors❑0.1 HP ❑l%-8 EXEMPTION FROM WORKERS'COMPENSATION DECLA•��i`• Clarifiers Solar Collectors • (This section need not be completed if the permit is for on $100) or F.A.U. - -- less). �� Dishwasher Solar Piping : Inc.Solar ❑9-15HP 016-15+' I certify that in the performance of the work for whi is issued, - Fixtures /moi✓iMicrowave • shall.not employ any person in any manner so as / subject to the Drinking Fountains Solar Tank 11 workers' compensation Laws of California / - • Date 2/ -rV--6 // S I - Device Boxes Pole Li ht 7� Signature Floor Drains Swimming Pool w/Spa 9 NOTICE: If,after making this declare-_.r .'"od become subject to the . - c Workers' Compensation provisions this `r• ode, you must forthwith • • Floor-Sinks .. _ - Urinal- , -. - 'Outlets_ • _ Range , _ _ _ _ comply .with such provisions or this permit shall be deemed revoked. • - CONSTRUCTION LENDING AGENCY. ))) -Water Closet • Switches Sign Gas Service L/-Outlets _ ia ..+ 9 . 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.) _ ' ,_ - Garbage'Disposal ' Standing Sections Interceptors --Water Heater.- !. Lender's Name ' Lender's Address - '- Kitchen Sink' ' . ' -Water Service ' . - • =y . . ,_ ! Generator ❑0-5KW ❑5-15 KW Trash Compactor. , OWNER BUILDER DECLARATION - I hereby affirm that'l aril exempt from the Contractor's License Law for the Lavatories Auto-Wash' - ' - following reason (Section 7031.5 Business and Professional Code: Any city or' . . county which requires a permit to construct,alter,Improve,demolish or repair p—Trap Laundry Trays - _ • 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 ROOF Drains -- - ' ,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 ' - - - , therefromand the basis for the alleged exemption. Any violation of Section. 1 Reinspection Fee , $15 Issue Fee $ 3 7031.5 ;by any applicant for a .permit subjects the, applicant. to a •civil ' - • - - /fir . :penalty of not more than five hundred dollars($500). - _ - ' DEVELOPMENT SERVICES REQUIREMENTS: I, as owner of the property or my:employees with wages as their sole Reins• pection-Fee' I , $15 • ' • Issue Fee ' $_3' ' :Zoning Approved By •compensation, will do the work,and the structure is not intended or-offered Date for sale.(Section'7044, Business and Professional Code: The Contractor's • - MECHANICAL - ' FEES. Building Approved By' Date • License t.aw.tloes not apply to-an owner of.a property who builds or improves ____ __ _ l t��/ ' thereon, and who does such work'himself/herself or through his or her own 'Application Issued Bye 1 Date �f% •• employees, provided that such improvements are not intended or offered for, Boiler: i Hood or Type I- ❑' sale. lf,'however, the building or'improvement is sold within one year of col- Canopy Type II 0 - SUMMARY OF FEES' pietion, the owner will have'the burden of proving he/she did not build or im-' Duct-Under Ground ,• r.' grove for the purpose of sale). - • - - - _ BUILDING PERMIT, $ . 'SMIP $ U • Las owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration-SSystem , PLAN CHECK $ ' PERMIT tractors to construct the project (Section 7044,Business and Professions Code: • - , i The Contractor's 'License Law does not apply to an owner of property who• Duct-Ventilating_ . • 00-100',000 BTU ❑10Q000-BTU PLUMBING $ `S,Oa ' ' ISSUANCE • $. • •builds or improves thereon:and who contracts for such oroiects with a-con- - - - -•- - -- - --- tractor(s) license pursuant ro the Contractor's License Law). I am aware that• Exhaust System 0 Multiple 0 System Repair/Alteration • PLAN CHECK , 25% $ ' - ENERGY P.C:' $ • .. proof off their Worker's Compensation Insurance should ,be provided to me., - ELECTRICAL $ " 'GRADING $ ' ❑ I am exempt under Section ' B. & P.C.for this reason ® Firepl/Fact.Blt. ICBG# t Fire Dampers • _ : El • ' • PLAN CHECK 50% $ MICROFILM : $ Date owner, Heating System&Ducting Registers I Ill'''' MECHANICAL, $ b.hereby certify- that I have read th 'nj .n and-state that-the-above ® ❑0-100,000 BTU 0100,000 BT - - - - • - - TOTAL FEE $' S• 9� information is correct. I agree to c ,-✓�1- all city and county ordinances . ® - - ■ . PLAN CHECK ' 25% $ - - and state laws relating,to build r----on, and hereby authorize pre- ® ®.• '/ • I sentativea of this city to en ,✓��/e above-mentioned propert forIII - Inspection purposes . L r , Signature Date t7-Z/ - it, _ ; • / • _ Issue Fee $ 3 , $15 ® 01 00009947—C0009947 TOT 5_00 0865-46,rev.5/88 white - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING POOL n SPA a APPROVALS Permit Date. _ Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Polg 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. , 53. Steel Reinforcement _ o 3. Electrical Conduit Utility-Undrgrnd. 54. Forms I -4�)Electricdl Conduit-Uhdrgrnd. 55. Electrical Bonding .1 A 54Steel:Reinforcement: , 56. Rough Plumbing & Pressure Test ' 6. Elect'ric3IUFERGrnd. - 57. APPROVAL TO COVER-GUNITE `.r 7"Footm , gs ' 58. Electrical Conduit-Undrgrnd. •8.•Foundation i 16 "r°.; 59. Gas Pipe, 0 Undrgrnd.,Test � i 9)Water Pipe-Undrgrnd. e. iF '• % 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10' Structural Floor System " -;' . 61. APPROVAL TO DECK . 11iProperty Sewer Line & House Connection s*: �, ( „ 62. Backwash & Receptor-Final 12. Sewer Cap , •t 63. Heater & Vent-Final ,J 13. Roof Drains • I 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 .-1'8'. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL •19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT '20. Rough Factory Fireplace APPROVALS Permit# c21! Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 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 Notes: 9_/_St LEFT C4eo. G.E.0 34. Final Heating & Air'Conditioning Iaief-M1Pzemir Earetb 41t$X elv.3 of L•C.t) 35. Final Gas Pipe-Test I 36. Hood or Canopy • 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final j 42. Backflow Preventer ,t)./ 43. Backflow Irrigation Ic.,: •cJ 44. Landscape Irrigation System 45. Sound Attenuation • 46. Handicap Regulations ,�. 47. FINAL STRUCTURE & BUILDING 48. Snecial Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co "�- . 51. CERTIFICATE OF OCCUPANCY �• I•=) - No. Date C.) - 11530 3( IS'(Bo V 4 COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE OEP1. P. O. BOX 917 COSTA MESA. CALIFORNIA tSA CM OF cost M M For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPEOORRpRIIN�T/f/) �/y BUILDING ADDRESS / , `L�l� �%�, da ADDRESS\r1�11�COSTAST( tv SAA(�C/lA//LIFFOy1R�N�IA� ^y/ For Office Use Only OWNER 1 r, I l Y I1J /B .. �J(j I{.L�.Y�MV I RECEIPT NO. I PERMIT MAIL 2 2 {I LfJ`] R Y DATE RECEIVED A IBB EDU ADDR SS �4J1 (lY�' Ej�� .3 �j5 4 V /1 /�- TEL.0 * BUILDING �f �� (Ale-/1 [�/�/�// CITY W.\ N0.1 R•1 ��0 ADDRESS � PLI-7 l Al/(/ () ARCHITECT TEL. OR ENGINEER NO. COSTA MESA. CALIFORNIA FIRE ADDRESS ,,�^1� , ZONE TYPE GROUP CONTRACTOR�JW • v APPROVED -�-}&BY ATE % c ADDRESS ZCNING ZONE IR q NO.OP USE OF NEW 2.L241 . CITY ��eT(Gq �r\/, I PIANS BUILDING ( .,01 , STATE T NO.\IS L( y `. TNO. \ I� �� 0 LEGAL //�� Y �(/�f- U I,/ �yL DESCRIPTION 0( I xit-1,- /5 1 I N�'I/l7 • SIZE I NO. OF BLDGB.t (� / " „//" OF LOT , NOW ON LOT CCCCCC////// p P.NO 9 1 7— ) zj7 — USE OF YARDS EVES EXISTING BLDG. APPROVED ALLOWED J SETBACK LINE FROM (CENTER LINE ST.) ///// i I �W� CENTER OF STREET REAR YARD FRONT 'WET. IS O 14- N. SIDE YARD I LEFT I RIGHT R.SIDE 2,./ SFT. ap/{^ I IN. DESCRIPTION�( OF WORK L.SIDE /�T. N. NEW I ,` II ALTERATION I II ADDITION REAR , J/A FT. IN. REPAIR I LOVING IIDEMOLISH BYPROVED// (� / /( DATE `-. .��e,n BUILDING4. NO. OF QQ n _ N/'/✓/.�L �y , SIZE X I ROOMS .IS•STORIES , /—"- .619. .os...flrg0F1.ososooKnA.•-• EXTERIOR WALLROOF COVERING i COVERING i'ai.�/ oma; air .”�__ -% USE FBBUIILLDIIINGG AND WORK TO BE PERFORMED / I- 1 , NV( / VI - , Me 6 ;o " .A wiY i c / / I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- THE AMOUNTE SHOWN HOEG A PUERMIT IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY IN CES AND STATE LAWS REGULATING BUILDING CO I./ I /] VALUATION ro ro SIGNATURE O'er/ (�TYn'^n^_ PERMIT FEE $LJ'/ N ERMITTEF �' `'1V^�^"-_ 5/7 � G� B_ (2,(717- PLAN CHECK $/O '� ORIZED AGENT "SD i ® TOTAL FEE $S� LLC