HomeMy WebLinkAbout3149 LIMERICK LN - Building Permits 014 CITY OF COSTA MESA
'115." \�-. P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200
,oili, j. DEVELOPMENT SERVICES DEPARTMENT
BUILDING DIVISION
NOTICE OF PERMIT EXPIRATION
July 02, 2003
Anthony Duarte
3149 Limerick Lane
Costa Mesa, CA 92626
PERMIT NUMBER (S): B02-01066 •
FOR: RE ROOF
PROJECT ADDRESS: 3149 Limerick Lane
Our records indicate the above listed permit(s) were obtained for property improvements
or alterations at the above address. Per the 1997 Uniform Building Code, Section
106.4.4 Expiration, permits are valid for 180 days from the date of such permit, or the
date of your last inspection for the project and additional fees may be required to finalize
expired permits.
According to our records, the permit(s) listed above have not had an inspection for a
period exceeding 180 days. If you have a signed inspection card indicating an
inspection was conducted within 180 days from the date of this letter, please contact this
office so we may correct our records.
A time extension may be granted if you intend to commence work and complete the
project. Requests must be made in writing addressed to Ed Petros, Chief of Inspection,
• at the above address, detailing circumstances and listing an estimated date of
completion. If you need to request an inspection please call our Inspection Request Line
at 714.754.5626. If you do not contact this office within 10 days, your permits will expire
on July 18, 2003.
If you have any questions, please contact the Building Division at 714-754-5273,
between 8:00 a.m. and 4:30 p.m., and a staff member will be happy to assist you. The
accuracy of records affecting your property is our goal and we appreciate your working
with us to resolve this matter.
Sincerely,
Mary Jane Weidenkeller
Office Specialist II
Building Division(714)754-5273 • Code Enforcement(714)754-5623 • Planning Division(714)754-5245
FAX(714)754-0656 • TDD(714)754-5244 • www.ci.costa-mesa.ca.us
CITY OF COSTA MESA PROPERTY DETAILS REPORT
3149 Limerick Ln
Costa Mesa, CA 92626-2654
Owner: Duarte,Anthony+ Duarte, Miguel Phone:
Resident: Norris, Mark P Phone: (714)546-3933
Site Address: 3149 Limerick Ln Tax Address: 3149 Limerick Ln
City/Zip: Costa Mesa/92626-2654 City/Zip: Costa Mesa/92626
Parcel Id: 141-023-16 Own. Occ.: Yes
Location: Costa Mesa City School District: Newport-Mesa Unified
Neighborhood: Unknown Census Tract: 063902
Wealth Code: 7.0 Year Listed:
Legal Desc.: N Tr 4355 Lot 75
Zoning: Unknown
Subdivision: Unknown
Usage: 122: Single Family Residential
Style: Unknown
Construction: Unknown
Year Built: 1963 Ttl. Rooms: 6 Blktop Paving: Unk.
Stories: 1 Bsmt. Type: Unknown Concrt Paving: Unk.
Bdrms: 3 Bsmt. Fin.: Unknown Carport: No
Baths: 2 Full Gar. Type: Attached Garage Deck: Unk.
Heating: Unknown Gar. -Cars: Patio: Unk.
Cooling: Unknown Gar. Sqft: Pole Barn: Unk.
Irr. Lot: - Unknown Roof Mater.: Unknown Pool: No
Terrainf Unknown Roof Style: Unknown Fireplace:
Water:_ Unknown Attic Type: Unknown Gas: Unk.
Sewer: Unknown Condition: Unknown Electric: Unk.
Sqft 1st: Lot Dim: Units:
Sqft 2nd: Lot Size: .14 acres
Sqft Bsmt: Lot Sqft: 6098.4 sq.feet
Sqft Total: 1377
Market Value: $214,200 Gross Tax Semi Ann.: $1,204.67
Assessed Land: $154,857 HB920 Credit Semi.:
Assessed Bldg: $59,343 RB Credit Semi Ann.:
Assessed Total: $214,200 RBA Credit Semi.:
Percent Improved: 28% Homestead Exemption:
Delinquent Taxes: Spec.Assmt. Semi.:
Tax Semi Ann.: $1,204.67
Sale Date: Dec-03-2001 Mortgage Date: Dec-03-2001
Sale Amt.: Mortgage Amt.: $207,000
Deed Type: Intrafamily Transfer Mortgage Type: Conventional
Volume& Page: Volume&Page:
Seller: Duarte Anthony Lender: Provident Funding As Sociales Lp
Title Company: Mortgage Term: 2031
Multi-Parcel: No Mortgage Rate: Unk./Fixed
The information is deemed reliable but is not guaranteed. 2001-2002 Tax Year Copyright 2003 Haines Printed Jun-06-03
SOUTH ORANGE CA
' , , MF- CITY OF COSTA MESA /
4 9 BUILDING DIVISION
q-' ,� DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
�• 1116 PERMIT
/B02-01066
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 3149 LIMERICK LN Status: ISSUED
Suite: Applied: 07/15/2002
Vicinity: ROOF Issued: 07/15/2002
Parcel Number: 14102316 Zoning: R1 R1
Applicant: BURKE, MICHAEL ISSUED BY:
Address: 1653 SUPERIOR AVE
Phone: (949)642-7222
COSTA MESA,CA Zip: 92627
Owner: DUARTE, ANTHONY
Address 3149 LIMERICK LN
_ Phone:
COSTA MESA,CA Zip:
Contractor: LEE ROOFING OF COSTA MESA
Address:. 1653 SUPERIOR AVE
Phone: (949)642-7222
COSTA MESA,CA
Zip: 92627 License: 349686
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF GARAGE ROOF ONLY. INSTALL.'\JEW 4 PLY CAP SHEET WITH HOT ASPHALT.600 S.F.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $2,000.00
Permit: $69.25 Claim Valuation: $2,000.00
SMIP Res: $0.50
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
•
Total: $69.75
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES:
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
WORKERS'CMPENSATION DECLARATION: .
I hereby affirm under penalty of perjury one of the following declarations:
❑ 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.
❑1I haCode,and will maintain workers'compensation insurance,as required by section 3700 of the Labor for the performance of the work for which this permit is issued.
My workers'compensation Insurancens� cam/pf�,nd potrl'Lv number are:
(Carrier:-1 S/I T1e !OG1•*//% y-✓AU` rpolicy Numb— ei�.
(This-section need not be completed it the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the performance of the wo. • hich this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of C..omia r.• :% at if I sh•uld become subject 10 the workers'compensation provisions of Section 3700 of he Labor Code,I shall forthwith
comply with these •:•�i• /`
Applicant'Signeture:-� ! „ ! Date: 75 l/ `L—
WARNING:FAILURETOSECUREWO: ERS'es PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TOCRIMIN7,775"—e•
PE TIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),I 'DDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES,
LICENSED CONTRACTORS DECLARATION:
I her by.affirm.that.l.am licensed under•rovisions of Chapter 9(commencing with Section 7000)of Division 3 of theBBusiness and Professions ode,and my license is In full
face.andeffect:Lic..e- i. . •i/ Ct lass#. �l
Contractors rdi ifIS Date:.
CONSTRUCTION LENDING AG - Y: •
❑ I hereby affirm that there i a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's 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).
❑ 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:
1 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? ❑Yes 0 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? ❑Yes ❑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? 0 Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit 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? ❑Yes ❑No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia 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 ins.- lion purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
44
t7ture Of L•al Owner(s) ate
C_,
`4.3".A-•Or Authorized,Applicant
to - }
CODE# . •. • PATh INTRIALS CODE* INSPECTION TYPE D INTITIAL$
1616 ixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 1 /{' 208 Final Plumbing
�/
200 Final Re-Roof -lo''QS 0i 1. 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
_ DATE uw ' 1811157 I JOB ADDRESS 3149 Tiriprj ek Lane y74_6''14{""6C arcrn--c. BUILDING PERMIT NO. 1s r c'
GENERAL CONTRACTOR" et7.me Hes•t33.g•- l:orp• 'i VALUE $15,287.00
AP No. LOT 75 TRACT 4355 FIRE ZONE DESCRIPTION OF WORK Res.w/att.Gar.
INSPECTIONS Signature DATE GROUP 1&J TYPE V ZONE RI-
F
lC Lf/ A-n-al PERMITS ISSUED
G— W 9-V- 8 SUBCONTRACTOR DATE I NUMBER
Water _l,/ Q-q C?
Rough Corn. Refrig. ❑ Air Cond. 0
Rough Heating le"/ -s Y4':i4 - alo'd�• 86 ,-
Rough Plumbing 477 ftc.-rc,L, /5„{2. ' /--3 to .3Ty.1 j'_ f,,
Miscellaneous
Prop.Swr.Line IR-House on. IQ St.Swr. lfr 1a -/-4_3_4" _ • 2-nit-A.3_�,`3 / _tre
' SprinklingSystem / t c.
Y G1 //-CS�c� �;uY a - L+
Construction Pole
' Underground 0 Power _
'Rough Wiring 7"- 3 d.7 7, °Ssi an, s-/-G a /7- JD0 ...--
Trenches
Trenches r Forms Er Steel Reinf. [� ./—/a-A2
Floor System A74/ /-3/-65-
Bond
-3/_6cBond Beam ❑ Steel Reinforce 0
Sheathing 1544; 3-=/-63
Frame and Flashin ef: /
Lathing — In Out it r // f -i'f'-(
Plaster, brown coat J� ' Snit-61_,
R'-'-+g. 0 Air Cond. 0 Final
I ng, Final './/C £ -/1,/,r
Plumbing Fixtures, Final ' .I2 62
Final Gas Test ale,le,
Electric Fixtures, Final / e- h-C3
`0* - 18457 FEE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT Lot 75, Tract 435 1 Paan 13m1a1a
P. O. BOX 317 COSTA MESA. CALIFORNIA F ANCrrEnnCCTTDppEPT.
For Applicant to Fill In Completely APPLICATIOF4j�ORFPER�IIT MESA
TYPE OR PRINT
BUILDBUILDING
ADDRESINSG 3/y 9 L,-.9,- e/Iv 4.P
COSTA MESA. CALIFORNIA For Office Use Only
OWNER Harbor Hall of Fame Homes, Inc. I RECEIPT NO. I d C�rh a S
MAIL RECEIVED BY DATE RECEIVED DATE ISSUED
ADDRESS P.O. Box 2066- �o I /a /,, /A- DEC 1 1 Inc"
CITY Santa Ana NWlI 9-2204 ADDRESS
ARCHITECT
OR ENGINEER JamisonTig:544-004 COSTA MESA. CALIFORNIA
NO.
ADDRESS 225 11011 St. , Tustin FIRE
ZONE TYPE 5- GROUPM14 cid-
CONTRACTORLlfetlme Residential Bldg Cor; APPROVED DATE
ADDRESS 2131 So. Artesia ZONING
ZONE NO.OF •-� USE OF NEWS.• -7.•.A At,
CITY Santa Ana 7C -IPLANS G I BUILDING k•/.. i..,
•
LIC.N 208676 No:KI 9-2204 LEGAL 1.•at 7-g- 7 °/�...i--1
LIC'NO• DESCRIPTION
SIZE1 I NO. OF SLOGS.
OF LOT 6000 NOW oN LOT 0 A.P.NO.
USE OF None YARDS EVES
EXISTING BLDG. op APPROVED ALLOWED
SETBACCENTERKOFI LINEFROM
531 REAR YARD 21)1 •O11 (CENTER LINE ST.)NT .S 7 FT. IN.
SIDE YARD I LEFT 5.51 I RIGHT 51 R.SIDE S— FT. IN.
DESCRIPTION OF WORKL.SIDE o� FT. IN.
NEW I X II ALTERATION I II ADDITION I REAR a V FT. IN.
REPAIR I II MOVING I II DEMOLISH I APBPPROVED /g�DA DATE /3/Z-"/!t
BUILDING NO. OF WPI
SIZE 14001 LLROOMS 8 STORIES 1
OOF
COVERING RIOR WALL PlasteItOVVERING Shake
USE OF BUILDING AND WORK TO BE PERFORMED
Single family residence
leene zt• . a..
c•E -/7&e - 2/67°-
I HEREBY ACKNOWLEDGE T- T I HAVE READ THIS APPLICATION THE AMOUNT SHOW NDER VALUATION IS FOR THE
AND STATE THAT THE ABO IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY .4;DI CES AND ST�+w LAWS REOU TING
BUILDING CONBTRU•.J'•N \ i� VALUATION �j /
SIGNATURE 0 -� i i 0' . . C//VI JJ '1 PERMIT FEE $ `�( N
PERMITTEE ""�1II �1 $ 75; o
, p((p7.-- PLAN CHECK $ I7�5-C4
AUTHORIZED AGENT �4 6-e.) 0
iliiiiiIr TOTAL FEE $ 4
"'••""` nada, }ALWHrtll n. a.7naa. 4 Z7-00
yX,• JOB ADDRESS 3149 limerick Lane BUILDING PERMIT NO. 25617
GENERAL CONTRACTORLOT DESCRIPTION OF WORK Patio Cover
AP No. 141-023x16. LOT TRACT FIRE ZONE VALUE $ {}Q6.00
* ""ECTIONS Signature Date GROUP L & J TYPE V ZONE R1
SUBCONTRACTOR PERMITS ISSUED
Gas • I Date i Number I Signature
Water Plumbing
Rough Plumbing
iProp. Swr. Line 0 House Con.0
Sprinkling System
Miscellaneous _
Rough Heating and Air Conditioning
Temporary Service or Pole
Underground 0 Power O
Rough Wiring Heating and Vent.
Trenches U Forms 0 Steel Rein'. O I_ .
Floor System
Bond Beam 0 Steel Reinforce 0
Sheathing
Frame and Flashing _
Lathing — In p Out 0
Plaster, Brown Coat
Structural, Final Electric
ng, Vent., Refrig. and A.C., Final
I-.__.ibing, Final and Gas Test O
Electric, Final I
Building, Final _ 9/4446
7----, hi _ •
25617
COSTA MESA BUILDING-SAFETY DEPARTMENT CITY flf,_CuSTA MESA
P.O. BOX 1200 COSTA MESA, CALIFORNIA 0212E
4
For Applicant to Fill In Completely AIPLCpp- pp099 O,Rp
R
TYPE OR PRINT BUILDING q"
fr
ADDRESS .'/1% LIMB r/[ k L•+A.c FU_`' •E'�N e1�J
COSTA MESA./� CALIFORNIAL' �� C�7OH17
OWNER /=DWARD N/]it-L RECE DOr DA �IVED4 —IM tErC 6,
MAIL BUILDING 7/JK] Jlo
ADDRW 3! ' ' L /M C r/'C 4' L A A4 e ADDRESS 9/f/ //�
'y ,I C TEL- ZONE TYPE ✓ OROUg,X }N
FIRE
CITY COS/ 44P-CA NO. //
APPROVED' UU
OR ENGINEER NO.ARCHITECT TEL BY' /` DATE
Ci ZONING o' 4_1/ -
ADDRESS
ZONE HO.OF ups or NEW jQ.�.�f'..t.V
�I PIANS � EUILDINO Vin ae /
CONTRACTOR •
Y--.14
`J �7 �f/V
LEGAL • / /s Tit.
..,—.R 4 �J sC
ADDRESS
DEGCRimox)) ''JJ ,,qq �/�/// J
CITY A.P.NO. / %/—C/ 23 _/V/
NOTE: NO SAVE OVERHANG SHALL BE LESS THAN
STATE - TEL SO•TO SIDE EI REAR P.L
LIC.NO. NO.
EAVES
612E .S8 / IGS / NOWON OTS. ALLOWED (U.B.C.REQUIREMENT)
OF LOT
YARDS APPROVED YARDS APPROVED
USE OP MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG.
(FROM C/L STREET)
SETBACK UNE FROM FRONT a(-JET.- o/--e---2c. PT.
CENTER OP STREET REAR YARD �-7
SIDE TARO I L.Fr I RIGHT R.SIDR /�PPT.
/r.
DESCRIPTION OF WORK L SIDE ( -( irLiC -c-- '• PT.
NEW X ALTERATION l)ADDITION REAR 9 PT. Ff.
11 DISTANCE BET. BET.MAIN a
REPAIR _MOVING DEMOLISH MAIN BLDOH. ACCESS.SLOGS.
BUILDING NO.OF VAR.SC DATE
SIZE ROOMS STORIES C.U.P.*D7 ,/� APPROVED
EXTERIOR WALL I ROOF (IS �P v(j IYY— 2S--106
COVERING COVERINGNY DATE
USEOFBUI INS'AND . •RK • SF PER [ 1 (��? 0.
a .JI j�
—.i
_016 USG.FT.
I HEREBY ACKNOWLEDGE THAT.I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE 9
AND STATE THAT THE ABOVE,IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT /E[ ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION
BUILDING CONSTRUCTION. ‘.._....--
ID
SIGNATURE OF /1 J G� PERMIT PEE f
PBRMITTBF �v ��//SJ� l/(//� / 0
j X PLAN CHECK S i.
w
AUTHORIZED AGENT
. ... .... .. ._ ,. . . a'.. .�.. TOTAL FEE S 6 r