HomeMy WebLinkAbout2732 LORENZO DR - Building Permits `O 'Ws CITY OF COSTA MESA
BUILDING DIVISION
. •,k': DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
r* PERMIT
%''° oe
RITMO PO4-00831
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 2732 LORENZO AV Status: ISSUED
Suite No Applied: 12/06/2004
Issued: 12/10/2004
Vicinity:
ISSUED BY:
Parcel Nunmber: 14168211
Applicant: CULLIGAN WATER
Address: 502 S LYON ST
Phone: 714-750-2233
SANTA ANA,CA Zip: 92701
Owner: BREHANY, JAMES J JR
Address 2732 LORENZO AVE
Phone:
COSTA MESA,CA Zip: 92626
Contractor: CULLIGAN WATER
Address: 502 S LYON ST
Phone: 714-750-2233
SANTA ANA,CA Zip: 92701
License: 663091
Arch / Eng:
Address:
• Phone:
Zip:
License:
SCOPE OF PERMIT
INSTALL WATER SOFTNER.
FEE SUMMARY
AMT QTY AMT QTY AMT QTY
ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0
Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0
Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain,Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0
Drain, Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0
Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92.28,§ 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections end final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
iNFhave and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued.
My workers'^^7----..9.0.i,compensation insurance carrier and policy nater are: /, 1/�
CarperC /M la-rn `QiZr'Q/q ____K,Ei ci Policy Number: r/V L_3 73 0 4/5-‘,I U
.f(�71il$Hse�fion need not be completed it the permit Is valued at one hundred dollars($700)or los ,__a.) `___
o 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 workers'
compensation laws of California,and egree tha f I should be ome subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall fdrthwlth
comply with the i° ovisions. /
;APPfi__t SIBn�etur� �J Date: / eDJ/U CHL
WARNING:FAILURE TO URE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBIECT- J3CRIMINAL PENALTIES AND CNIL FINES UP TO ONE HUNDRED
THOUSAND DOU,ARE( O03).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR COOE,INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
1 he�y.affirm.that lam Ilcensed underrprovisions of Chapter 9(commencing with Section 7000)of Division 3 of the Busine�n Pr fe ions Code,and my license is in full
force.and effect-11c.# . sans
/r'.. � -O assN�
Contractor's Slgnaf riw . :N V A3-Q Date:. ,P- • a
/
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.(Sec.3097,Civil Code).
Lender's Name: Lender's 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 properly,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 driver's license. ❑Yes 0 No Driver's 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 Safely 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? ❑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? 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 end 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 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 aaermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes I I 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 California Health and Safety Code).
7 If a permit from the South Coast Alt(Duality 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? 0 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 properly for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
/� Signage Of Legal° ner(s) Date
p��_ :-- , th l a�ia v (5/-77l� IC- And/Or Authonted.Applicant 's- err' Date
?ADE t, RISPECTIONTYP6 PEI 'MITIALS CODE! INSPECTION TYPE PATE INIMALs
1616 Fixed System Final Fire Prevention 206 Final Mechanical �
1266 Pool Spa Final _ 208 Final Plumbing ['A/_
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
.._, .
JOB ADDRESS"'- 2732 Lorenzo Avenue BUILDING PERMIT NO. 261489
GENERAL CONTRACTOR Woody Construction Co. DESCRIPTION OF WORK Add Rumpus Room to res.
AP No. 11+1-682-11 LOT TRACT FIRE ZONE VALUE §1,000.00
I. ECTIONS Signature Date GROUP 1 TYPE V ZONE R-1
S. PERMITS ISSUED
Gas SUBCONTRACTOR Date I Number Signature
Water Plumbing
Rough Plumbing
Prop. Swr. Line 0 House Con.0
S.rinklin_ S stem
Miscellaneous
Rough Heating and Air Conditioning
Temporary Service or Pole
Underground 0 Power 0
Rough Wiring ./t'' -ff.". ' Heating and Vent.
Trenches 0 Forms 0 Steel Rein/. 0 ,_Ld_4.7
Floor System
Bond Beam 0 Steel Reinforce 0
Sheathing /-/.2.-67
Frame and Flashing°
Lathing— In al..-- Out 0MAI a ( 7
Plaster, Brown Coat
St--•tural, Final Electric
1 ig, Vent, Refrig. and A.C., Final .- - _ /4,4„,_ -, D,- /-/7-e7 .2&7790
Plumbing, Final and Gas Test 0
Electric, Final rMa��a"'1
Building, Final ; -. '
r
2E489 DEC 30-66 001012 *****6.00
a
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 02020
For Applicant to Fill In Completely APPLICATION FOR PERMIT
� / BUILDING
TYPE OR P NT 6`
BUILDING 7 / " For Offke Us. Only
ADDRESS 1.. f� ' Acr-
// RECEIPT NO. PERMIT O
COSTA MESA. CALIF•RI�17� I �•
OWNER
:'fie ra�� RICE/ M REc IVED ILS [D
OWNER �'"�LV (� - -, ^ Z Z. n
\���� BUILDING hhhJJ./
AD
MAIL.
/ eJ7�/' 1"95C-2-2-
.-4 ADDRESS / /O� '�/ L(P
EIRE
CITY c -rL 1/C`�T T
NO. ZONE / T1'P a-OUP _
APPROVED3 29
ARCHITECT EL BY' /� DATE
_ TNQ.
ZONING ).1?7c0,
',FORMES
NO.OF USE OF NEW O rr I..O
/� � J ( 75:......) I PLANS...7 OUILDINO 9 /. )Yr/
CONTRACTOR t
/14 2-` 0r
,..„4,,,,) L.-O 1 ( ,{ �T' Q47Y/1
�Y(��Y//�/
AlamD[SCRIRION / 6 /.4 1 � 47(1/1 I' rjCITY / 0}, A.P.NO. (�I Y/ /7 L —II
STATE / (may/- `, - THL NOTE: NO SAVE OVERHANG SHALL BE LESS THAN
STATE . a v a ` NO. / • j, / O dy SO-TO SIDE B REAR P.L.
VES
SIZE Inc^ ? I N..0PSLDGS. ALLOWED (U.B.C.REQUIREMENT)
OFLOT (n -� NOW ON LOT
USE OP X-C-re-4,-)C-
'
(((// p YARDS APPROVED YARDS APPROVED
EXISTING BLDG. // "'!'1VMAIN BUILDING ACCESSORY BUILDING
(FROM C�( �//LSTREET)
SETBACK LING PROM FRONT/til 1—FT. PT.
CENTER or STREET REAR YARD
SIDE'CARPI LEFT I RIGHT N.51DR�7-FT• FT.
DESCRIPTION OF WORK L slot 5 Fr. Fr.
_ ALTERATION_ ADDITION EAR 1Z--PT. FT.
-
DISTANCE BET. BET.MAIN B
REPAIR _MOVING DEMOLISH MAIN BLDGS. ACCESS.SLOGS.
BUILDING O.OF - VAR.# 2�-4 G DATE /I/
SIZE �i V^ F I 0 ROOMS I /�STOORIES / C.V.P.* -r ' APPROVED /2,4/((C>~/
CEXTERIOR RINGWALLJYG L. COVERING i Y�(1 I� :YFROV h /// DATE I ZI zl /lG�/
USE OF BUI LDINS AND WORK TO BE PERFORMED 1� 0,
il
/ _ 4 /72r-int"--1 //n yam//,
!/// tY s6 SO.FT. 1
I HERESY ACKNOWLEDOE THAT., HAVE READ This APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE C
AND STATE THAT THE ABOVE.IS CORRECT AND AGREE TO/,COY. PURPOSE OP ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES ENATS LAWS KM TING VALUATION • 00
BUILDING CONSTRU �•(l / / /
SIGNATURE C/,J/ PERMIT FEB S V�
PERMITTEr
/ s I 000 PLAN CHECK S W
AUTHORIZED AGENT /'� ��
a .....m. . I TOTAL PEE $ (�J
OWNER BREHANY, JAMES DATE FEB 1 ? 1964
JOB ADDRESS2732 Lorrenzo Street BUILDING PERMIT NO. .21592 -
GENERAL CONTRACTOR AM Patio and Screen VALUE $ 1100.00
AP No. LOT 111 TRACT 14Y91t FIRE ZONE 3 DESCRIPTION OF WORK Patio Roof
ag INQPECTIONS Signature DATE GROUP J TYPE ]y ZONEISSUED
Rl
O. SUBCONTRACTOR DATEI
TS
G. NUMBER
✓o Water
C Rough Corn. Refrig. 0 Air Cond. 0
C Rough Heating
Rough Plumbing
Miscellaneous
Prop. Swr. Line❑ House Con. 0 St. Swr. 0
Sprinkling System
Construction Pole
Underground 0 Power 0
Rough Wiring —
Trenches Forms ❑ Steel Reinf. ❑
Floor System
Bond Beam 0 Steel Reinforce 0
Sheathing
Frame and Flashing
Lathing—In 0 Out❑
Plaster, brown coat
^g' ❑ Air Con. 0 Final
w r,
�;�#A�;?..�g, Final
Plumbing Fixtures, Final
Final Gas Test
Electric Fixtures, Final
Building, Finalel'C.Shten- flcfl-lleil c 79 Ti 7-1.4 r
OCCUPANCY •
Form BU4--6M-3-63—S-B P 21592
r 21592 FEE RECEIVED
-'COSTA MESA BUILDING-SAFETY DEPARTMENT FEB 14 1909
P.O.BOX 317 COSTA MESA.CALIFORNIA FINANCE DEPT.
CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
For Office Use Only
BUILDING/X.7
ADDRESS /7•17"1-07/0 RECEIPT NO. P RMIT NO
COSTA MESA, CAI IF NIA ,111/ �_S-�/ �Y
/fA{j/�Af', - 8 ` e A a lei RECEIVI 7 IA.,RI ?2 I ATE ISSUED‘r.
OWNER �(. w� 9 1_ // �jG (P1i (// /`'J/ —MAIL
/ 7`�' BUILDING
ADDR J//Zi� . FIRE
ADDRESS ;;//// -- /,�jJ�2�/�/
//N /J TEL. ZONE rte.- GROUP le
CITY /� t, <X NO. -
V / �j
/ /
APPROVED
ARCHITECT TEL. BY DATE
OR ENGINEER NO.
ZONING A" . %'
A\ SS ,'r`
Z � NO. P U860fN[W,j-
/?9' "..52.,“4,--
/ ' lie
I PLANS 7 I BUILDING '
LEGAL
CONTRACTOR�(///yy(./ �(/ ,j�'./J��n/.(,Ct- �}~ /�
/�/Y l/ //Y A/ DESCRIPTION ). aI- / L( L/ I `y'
ADDRESS a,f ./(� /AL// /J Lunt,
I
A.P.NO. �^-- �
CITY
�/77// n
NOTE; SIDE a OVERHANG SHALL BE LESS THAN
STATE TEL. 7 �/ sr TO SIDE 8 REAR P.L.
LIC. E NO. JI— J
EAVES
OSIZLEOT int- 13 NO.OFBLGGS.NOW ON / ALLOWED (U.S.C,REQUIREMENT)
F
USE OF / YARDS APPROVED YARDS APPROVED
EXISTING BLDG - MAIN BUILDING ACCESSORY BUILDING
_ (FROM C/L STREET ,(
SETBACK LINE FROM .�
CENTER OF STREET - REAR YARD FRONT FT.
I -- e�R.SIDE {- ,/FT, FT.
GIDE YARD LEFT R16HT /
DESCRIPTION OF WORK L.SIDE , PT.' Fr.
NEI" /,ESALTERATION ADDITION REAR / 5 FT. FT.
DISTANCE BET. BET.MAIN Q
REI-,.,R MOVING DEMOLISH MAIN SLOGS. ACCESS.BLDGS.
VAR.# DATE
BUILDING NO.OF
SIZE ROOMS STORIES 2.. C.U.P.4 // APPROVED
EXTERIOR WALL I ROOF COVERING BTPROVED I ( � it// �R ^ '_Ito
COVERING _ tam/1/, ,...„
y
USE OF B ILDING AND WORK TO BE PERFORMED
ley/_
$Q P<.
7071
N
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE F
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. 0
PLY WITH ALL CITY ORDINANC AND STATE LAWS REGULATING VALUATIONm
BUILDING CONSTRUCTION. PERMIT FEE $ 7--- o
SIGNATURE OF O
P ER M ITTE F //m.6t
$�/DOS C EC i .co� O
^D i
✓ AUTHORIZED AGENT TOTAL FEE $ 1/3e•S
19482 . T ,
1COSTA MESA BUILDING-SAFETY DEPARTMENT •LI n 2 1963
P.O.BOX 317 COSTA MESA,CALIFORNIA
'1412.1'~CE DEPT.
For Applicant to Fill In Completely APPLICATION FOR IPERMTITMESA
TYPE OR PRINT BUILDING
For Office Use Only
BUILDING 2732 Lorenzo Avenue �.E
ADDRESS RECEIPT NO. IP,! yr�q�
COSTA MESA. CALIFORNIA .UJ4SV-[
RECEIv;o BY -Arq ..3IIZ or IBs8Eo
OWNER Macao Realty Company {Zi _s d I L tl 1yg;
MAIL BUILDING
ADDRESS 3800 E.Ceast Highway ADDRESS
FIRE
CITY Corona del Mar.Calif. NO OR 34220 ZONE TYPE GROUP �pi
ARCHITECT TEL. ByAPDATE DATE
OR ENGINEER Macco Realty. Co No. OR 34220
AD. as same as above ZONING 1(I Ay
- Rr OF USE OF NEW Sa,LVCyll 1 .
ZOX
`�_ I PLAXNo. B I BUILOINO, / ((ff ;
CONTRACTQR MaCCO Realty Co
LEGAL
ADDRESS same as above DESCRIPTION Lot 14 - Tract 4784
A.P.NO.
CITY
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
LIC.TNO. 207343-A-SBI pp OR 34220 30'TO SIDE @ REAR P.L.
I No.OF EAVES
SIZEOF LOT 6S' X 9311 NOW Ory wTr.non �ALLOWED (U.B.C.REQUIREMENT)
YARDS APPROVED YARDS APPROVED
USE OF 'none MAIN BUILDING ACCESSORY BUILDING -
EXISTING BLDG.
50' (FROM C/L STREET)
CENTER OF
SETBACK I SIZE 6NE REAR YARD 31'6^ FRONT c('^FT. FC.
LI
SIDE YARDI LEFT 5'611 I RIGHT 5, 611 R.SIDE C Fr.E: Fr.
DESCRIPTION OF WORK 5 L.SIDE Fr (, Fr.
NEW X ALTERATION ADDITION REAR ,3 / FT. (, FT.
DISTANCE BET. BET.MAIN @
REPw,K MEWING DEMOLISH MAIN BLDGS. ACCESS.BLDGS.
BILDING VAR.# DATE
SIZE 54'x41'6" ROOMS 7 STORIES.24, C.V.P.# APPROVED
EXTERIOR WALL ROOF ,¢��p,+�'p�� ,ZeL.I.2.4V APPROVEUie ,,)
COVERING stucco I COVERING��+1 gle BYRimini DATE S ./-0-6S
USE OF BUILDING AND WORK TO BE PERFORMED
Single Fam.Res. W/Att Garage
PLAN NO 500-BR
Dwelling-2266 S.F. Gar-460 S.F. o
So.FT.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE F'
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION N
BUILDING CONSTRUCTION
MACCO REALTY CO. PERMIT FEE $ 26----- j
SIGNATURE OF
m
PERMITTEE
y- / $ 23, .-3
925.00 PLAN CHECK $ .5-0a.
AUTHORIZED AGENT / / [ 4
OC -��'�� TOTAL FEE 5
/` �"Jb
1''