HomeMy WebLinkAbout2850 TABAGO PL - Building Permits Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. -•
t - PE MIT NO, TRACT NO. - LOT NO. UNIT
CITY OF COSTA MESA CON�$,TFjUCTION PERMIT •
"_ ' . ' . .
��'�!> ' Q o pi • ��10 �� 3409 6!22/85 5.00 .TL
Project Address r, y� + L -
Applicant's Mailing Address #R Thr /L / TYPE OF CONSTRUCTION rvEw U ADD, U,ALTERATION SCJ_REPAIR - A
II ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# _ Zone
Owner's Name. ='--r {' Phone a" 7 `{ DESCRIPTION OF WORK/USE OF BLDG. ' —
•
Address - S Main Building: . Accessory Building:
r � E Z
Arch/Eng. License No. TYPE OF PERMIT Li GRADING OUNDATI ON ❑ STRUCTURAL ! T Front 0
❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL B "- N
Address. Rear •
Contractor's Name �. dZLm 0 ❑ :OTHER - A • • ' . I •
CK Right N
Address(mailing) " �NA' • II i� Phone /��/� PROJECT DESCRIPTION SQ. FT. OCCUPANCY ' -
•
�1 �J CONSTRUCTION TYPE • VALUATION $ S�Left
City License No. 6/'(i ZONE GRADING CU.YDS.
ACRES R
LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided _ E
I hereby affirm that am licensed under provisions of Charter 9 (commencing Remarks: 1 Planning Notes: M
with section 7000) of Division 3 of the Business and Professions Code,and -
VVV my license is in fulLf• . .ntl effect. % T
License ,y s - / Of Lie' e s •. O +'
-
\ Date ' J ` ' Signature s.�/ eaeai PLUMBING FEES
F- •s ii
1 WORKERS'COMPENSATION DE or Bar Sink Showers
I hereby affirm that I have a certificate of consent to self-insure a certificate ELECTRICAL FEES
of Workers' Compensation Insurance, or a certified. copy thereof (Section ._ Backflow Preventer' - Service Sink - - - - ' -
3Boo, Lab: C�.) �1 /; �y.- ,•z ' _ Automatic Washers Transformer ❑ 15-50 KW • ,
Policy No. `^J—�Spr-��`7 IO1 Company /\[I�a /r Backflow Irrigation Sewer Ca �I - 0 50+ KW
P Construction Pole Sub.
Miffed copy is hereby furnished. '
Certi cglay is filed with the city eu g Y na 1!/ J /� Bathtubs • Sewer Connection' Cooking Unit '-- Metes Oup to 100 amps
Date0.(/y/5 Applicant (/fin ,(j (✓"'// '
EXEMPTrON FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher • Meter Dover 100 amps_j. •.
(This section need not be completed if the permit is for,one hundred ($100)or
less). ' Dishwasher Solar Piping I Dryers ❑Gas DElectric Sub Panel
I 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 Drinking Fountains Solar Tank Fan - Motors❑0.1 HP ❑1%-8
' Workers'-Compensation-Laws of California.
.,Date Signature Floor Drains; Swimming Pool w/Spa —
F.A.U. •
'NOTICE:If,after making this declaration, you should become subject to the Inc.Solar ❑9-15 HP 016-15+
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks - - Urihal - - Fixtures - • - - - -
comply with such provisions or this permit ,shall be deemed revoked. Microwave
CONSTRUCTION LENDING AGENCY - Gas Service Outlets -
IpsQt ' •
I hereby affirm that there is a construction lending agency for the performance • J/�'-' - -y Device Boxes .Pole Light
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors '( Wate H t rY )v Outlets
Lender's Name Range •
•
Lender's Address _ - Kitchen'Sink' Water Service _ Switches Sign
OWNER'BUILDER DECLARATION i ' •
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories - Auto-Wash - oral Garbage Dis
following reason (Section 7031.5 Business and Professional Code:'Any city or 9 P ;,Standing Sections
• 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 P—Trap Laundry Trays 1 Generator ❑0-5 KW❑5-15 KW Trash Compactor
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 - _ _ - - ' •
•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 • •
' O I, as-owner of the property or my employees with wages-as their sole .Reinspection Fee ! '.$15 Issue Fee i ' $ 3
compensation, will'do the work,and the-structure is not intended or offered - Reinspection Fee • I $15 Issue
$ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES
' License Law does not apply to an owner of a property who builds or improves - , •
thereon, and who sloes such work himself/herself or through his or her own Boiler '" Hood or Type I 0 DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered foryp - ZOnin A roved R '
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II ❑ g pp y Date
pletion, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground •Building Approved By ' Date
rove for the purpose of sale). //��,�, � ,,ffes�
O I, as owner of the property, am exclusively contracting with licensed con- ' Duct-Structural . 'Refrigeration System Application Issued By Dat '� �'
tractors t0 construct the project (Section 7044,Business and Professions Code: -S
' The Contractor's License Law does not apply to an owner of property who Duct-Ventilating _ 00-100,000 BTU ❑100,000 BTU 1 SUMMARY OF,FEES
builds of improves thereon,and who contracts for such projects with aeon- - _
•
' tractor(s1 license pursuant to the Contractor's License Law). I am aware that ' Exhaust System I: Multiple 0 System Repair/Alteration - BUILDING PERMIT $ SMIP $
proof off their Worker's Compensation insurance should be provided to me. -ry PLAN CHECK $ /-� PERMIT
❑ Cam exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBG# Fire Dampers •
PLUMBING $ �O UPERMIT
ISSUANCE $
Date 1 • 1 OwnerHeating System& Ducting Registers • PLAN CHECK 25% $ ENERGY P.C. 1$ •
I hereby certify that I have read this application and state that-the above 00.100,000 BTU 0100,000 BTL - ' - - ELECTRICAL ,$ i GRADING $
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize repre- • - PLAN CHECK 50% $ • MICROFILM $ '
sentatives of th' ci to ent'r 'upon the .bove-mentioned pr tyy for _ • �`�
inspection Pur... s , / 'j��r / MECHANICAL $ '51'0 '
Signature •A / i.
_ Reinspection Fee $15 Issue Fee • $ 3 PLAN CHECK 25% '$
CMF 0865-46,rev. 10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANNING - POOL &SPA
APPROVALS Permit# Date Inspector APPROVALS Permit.# Date Inspector
1. Temporary Electrical Service or Pole - 52. Pool & Equipment Location
A
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
1 3. Electrical Conduit Utility-Undrgrnd. 54. Forms .
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement - 56. Rough Plumbing & Pressure Test
6. Electrical UFER 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, ❑ Undrgrnd.
10. Structural Floor System ,/ „La 61. APPROVAL TO DECK
11. Property Sewer Line & Houde 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
18. Rough Electrical-T Bar Ceiling - 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating& Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. 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 PREY. 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: 0845 GOR2/27/1.On •G
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace ``,,
38. Final Plumbing (� neerice°
39. Water Service-Final TTTTTT
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. Special Requirements Completed -
49. Electric Release to Edison - • -
50. Gas Release to Southern California Gas Co • .
51: CERTIFICATE OF OCCUPANCY . -
Nn. Date
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. 17O2 4/23/05 54TL
CITY OF COSTA MESA PERMIT NO. TRACT NO. LOT NO. BLD N0.
CONSTRUCTION PERMIT 9 1 8SS7tI
Project Address �_ i Z� .. - Y _ TYPE OF CONSTRUCTION ❑ NEW L ADD y ALTERATION LJ REPAIR
•
Applicant's Mailing Address . ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.4 Zone
Owner's Name e� Phoneme f-1 7'9/� DESCRIPTION OF WORK
�-•R / S Main Building: Accessory Building: 2
Address YJZP/ .CL 9� �a`��+G TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION T 0
U STRUCTURAL E Front N
Arch/Eng. License No. ❑ TENANT ❑ ELECTRICAL XPLUIVIBING ❑ MECHANICALB 1
A Rear N
Address p� ,,,f ❑ OTHER
y-c-A/04) Phonas424' PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right G
Contractor's Name ,�__
Address(mailing) //'570 .. 4�'d O� SrAwrt t/ CON ST RUCTION TYPE VALUATION$ S Left R
J E
3{i�gs7 ZONE GRADING CU. ACRES Ping. Ref.# Park.Fees $ Q
City License No. �f A� A n U
LICENSED CONTRACTOR DECLARATION Remarks:Ve C'3�7,/ .j.C./f J C/O Parking Req./Provided 1
P. I hereby affirm that I am licensed under provisions of charter 9 (commencing 'L�I/t� %%"� r' R
with section 7000) of Division 3 of the Business and Professions Code, and Use of Building: E
my license is in full fo ce and eff•ct.
Ucen ass — e No -- •'-dr PLUMBING FEES Planning Notes: M
Date -- Signature e.. �•- er E
Bar Sink Showers
N
WORKERS' OMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self-Insure or a certificate T
Backflow Preventer Service Sink S
of Workers' Compensation Insurance, or a certified copy thereof (Section .
3800, Lab. C.) Backflow Irrigation Sewer Cap ELECTRICAL FEES
Policy No. Company -- - •
BCertified copy is hereby furnished. Bathtubs Sewer Connection . Automatic Washer Transformer 0 15-50 KW
Certified copy is filed with the city Building Division.
Date Applicant Clarifiers Solar Collectors .
Construction Pole Sub. ❑ 50+KW
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION •
Dishwasher -
(This section need not be completed if the permit is for one hundred ($100) or Solar Piping Cooking Unit Meter ❑up to 100 amps
less). DrinkingFountains
I certify that in the performance of the work fpr which this permit Is issued, Solar Tank Dishwasher • Meter Dover 100 amps
shall not employ any person in any manner so as Com sub' ct to te
Workers'-C�fP�f�sflloa-Laws of California Floor Drains Swimming Pool w/Spa Dryers ❑Gas ❑Electric Sub Panel
Date `f/! !Y'-e Signature
NOTICE:If,after making this declaration,you should bec e 5 ject to the Floor Sinks , Urinal Fan -
Motors 001 HP 01%-8
Workers' Compensation provisions of the Labor Code, you m st forthwith .
comply with such provisions or this permit shall be deemed revoked. Gas Service Outlets Water Closet F.A.U. •
Inc.Solar 09-15 HP 018-15+ •
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance Interceptors Water Heater Fixtures Microwave
of the work for which this permit is issued (Section 3097 Civ. C.) _
Lender's Name • Kitchen Sink • Water Service Device Boxes Pole Light
Lender's Address - /� eV BUILDER DECLARATION . Lavatories t/4- cr
Sn ^) - - Outlets Range
I hereby affirm that I am exempt from the Contractor's License Law for the p_Tfa L"
following reason (Section 7031.5- Business and Professional Code: Any city or p' Switches Sign
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 Roof Drains - Garbage Disposal Standing Sections
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 Generator 0o-5 KW 05-15 KW Trash Compactor ,
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 civileenReinspection Fee ,I $25 Issue Fee $ 3
alty of not more than five hundred dollars($500).
et
U I, as owner of the property or my employees with wages as their sole MECHANICAL Reinspection Fee $25 Issue Fee $ 3
compensation will do the work,and the structure Is not Intended or offered _ FEES
for sale (Section 7044, Business and Professional Code: The Contractor's ---- - _- - - - -- PUBLIC SERVICES REQUIREMENTS:
License Law does not apply to an owner of a property who builds Or improves Boiler Hood or Type I 0 •
thereon, and who does such work himself/herself or through his or her own -- — Zoning Approved By - Date
employees, provided that such improvements are not intended or offered for Duct-Under Ground Canopy Type II 0 ,
sale. If, however,the building or improvement Is sold within one year of com- Building Approved By Date
pletion, the owner will have the burden of proving he/she did not build or im-
rove for the purpose of sale). Duct-Structural Refrigeration System Application Issued By /4t0 Date -2.3-2'1
I,as owner of the property,am exclusively contracting with licensed con- ❑0.100,000 BTU ❑100,000 BTU
tractors to construct the project(Section 7044,Business and Professions Code: Duct-Ventilating SUMMARY OF FEES
The Contractor's License Law does not apply to an owner of property who '
builds or improves thereon,and who contracts for such projects with a con- Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $
tractor(s) license pursuant to the Contractor's License Law). - PLAN CHECK - PERMIT
CII am exempt under Section B.&P.C.for this reason . Firepl/Fact.Bit.ICBG# PLUMBING ✓fu$ -� �12D ISSUANCE $
Date Owner, Heating System&Ducting _ PLAN CHECK 25% $ ENERGY P.C. $ •
I hereby certify that I have read this application and state that the above ❑0100,000 BTU 0100,0008 •- ELECTRICAL GRADING $ -information Is correct. I agree to comply with all city and county ordinances $
and-state laws relating,to building construction,and hereby authorize re re- MICROFILM ,$
sentatives of th I nter pon the above-mentioned
''llpr ert for PLAN CHECK 50% $
ifi
inspection aur ' Date 7�e MECHANICAL $ TOTAL FEE $ 00
Signature Reinspection Fee $25 Issue Fee
IF PLAN CHECK 25% - \ .
Drivers' LicenseodY'77'
CMF 0865-46 rev.12/83 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod -Assessor -
CONSTRUCTION AND PLANNING _ POOL.&SPA
APPROVALS Permit Date Inspector 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,JUndrgrnd. ,•' 54. Forms _ - - �
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding - . .
5. Steel Reinforcement l "- 56. Rough Plumbing & Pressure Test -
6. Electrical UFER Grnd. .- 57. APPROVAL TO COVER-GUNITE 2.
7. Footings ' ' 58. Electrical Conduit-Undrgrnd. - '
8. Foundation 59. Gas Pipe,'O-Undrgrnd., Test
9. Water Pipet-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. i 63. Heater & Vent-Final - - ry'
13. Roof Drains .64. Plumbing System - Final - ' - -
14. Rough'Plumbing 65. Electrical-Final - c f
15. Rough Electrical-Conduit - • 66. Solar System-Final - ' - "-' 1 -
16. Rough Electric Wiring • 67. Fencing& Access Approval - • • -- • -' "- - xi
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING ; • ,
18. Rough Electrical-T Bar Ceiling, 69: POOL/SPA SYSTEMS FINAL -
19. Rough Heating & Air Conditioning • FIRE DEPT.-REQUIREMENT, ' -
20. Rough Factory Fireplace APPROVALS ' Permit# - : i t', i 1
, 21. Ducts, in Structure 70. Underground Hydro • .
22. Ducts, Ventilating / 71. Product Piping•O Gas OOil ' ' •.
23. Gas Pipe-Rough&Test 72. Underground Flush z
24. Roof Framing • 73. UndergEnd.Storage Tank O 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 ISSUEDi
33. Final Electric Notes:,
34. Final Heating & Air Conditioning I •
35. Final Gas Pipe-Test
. I .
36. Hood or Canopy
37. Final Factory Fireplace - - -
38. Final Plumbing 4/2g-6/ LED - - .. •
39. Water Service-Final i:'
40. Gas Service-Final I
T
41. Solar Domestic-Final - - ) '
42. Backflow Preventer - _ ,� •
43. Backflow Irrigation - ' ' _ •
II
44. Landscape Irrigation System - ,
45. Sound Attenuation _
.
46. Handicap Regulations - - '
47. FINAL STRUCTURE & BUILDING ; .
48. Special Requirements Completed ! •
49. Electric Release to Edison - "" ,
4.
50. Gas Release to Southern California Gas Co • 1 . , r
51. CERTIFICATE OF OCCUPANCY
i
No. Date _
ral)I o-(d4G,up, ' ft �+ ".. - 's L farts, 60
Lot 44 13964 % - Art
I,.AR b i329 ���
COSTA MESA BUILDING-SAFETY DEPARTMENT V -\T 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 FBUILDING
BADUDILREDIN68G 2$O& TOT6‘0„,-‘,,T6‘0„,-‘,,T6‘0„,-‘,, \�t.
COSTA MESA. CALIFORNIA For Office Use Only
Investors Marine Inc. I RECEIPT NO. I ipyiMdyNO�
OWNER Cb.�M1V-•'+.!
MAIL RECEyaO BY DATE RECEIVED DATE ISSUED
ADDRESS 16nn w Creast Highway �`'' 1-e.-b II 1•�a.4 R ;OC.
CITY Newport Beach,Calif. NO.M�- BUILDING +gy p ,/vim
ADDRESS rsC ]J I/+' /�#
ARCHITECT Same TEL.
OR ENGINEER NO. /f-+2'igrCP OSTA MESA. CALIF NIA
FIRE
ADDRESSI/ r
ZONEIRTYPE ✓ GROUP vx
Mesa Verde Builders, Inc. APPROVED
CONTRACTOR BY DATE
ADDRESS 1653 Minorca Drive ZONING
Costa Mesa,Calif. ZONE Q i I NO.OF USE OF NEV7II�b 1
CITY - \ PLANS2.--I BUILDING !z'• / i
STATE NO. Ki 9-0395 LEGAL ) .'-k-"4-.
-�• 'F 4, Gf/H�y.�Y�t
LIC.NO. 181269 DESCRIPTION \r• 1 O C J (�
SIZE 74.501 X 1001 I NO. OF BLOCS.O
OF LOT NOW ON LOT A.P.NO.
USE OF YARDS EVES
EXISTING BLDG. G APPROVED ALLOWED
4
SETBACK LINE FROM 45.1 25I (CENTER LINE ST.)
CENTER OF STREET REAR YARD FRONT 4..•. FT. IN.�
SIDE YARD I LEFT 7 • I RIGHT 71-611 R.SIDE 7 FT. CTN.
DESCRIPTION OF WORK
L.SIDE 7 FT. IN.
NEW I X II ALTERATION I II ADDITION I REAR FT. IN.
REPAIR I II MOVING I II DEMOLISH I APPROVED DATE ----3--4,/
SIZEButuoINg.600 Sq.Ft. ROOMS 6 STORIES NO. OF 1
EXTERIOR WALI�sidlug ROOF JMila1e
COVERING B4 atucc COVERING Q.P— /(p w p
USE OF BUILDING AND WORK TO BE PERFORMED_
Single family residence aria garage p ^ 41(90'
Model No. .20-A (�
/�Ir Attached Garage 462 Sq.Ft.
I HEREBY ACKNOWLBDOF T AT I HAVE READ THI AP IICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT tTNE AB IB CORRECT AND A RE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY[ORhIN ANCRS ANlo
STATE LA GULATINGBUILDING �7 r�
SIGNATURE O CONSTRUCT!
:r/7 i 4.L.N ` /�,l i VALUATION Jo PERMIT FEE $ 737—
PERMIT-ME
—
PERMITTEE / 1(`/`' /4„/Li 1�lll// / 7/ a S.2 // e_
I $ j PLAN CHECK $ � lit S�
AUTHORIZED AGENT 5cSO O
TOTAL FEE - J