HomeMy WebLinkAbout2335 Ticonderoga Way - Building Permits ADDRESSORSMLTAND 2335 TICONDEROGA HY uta: CITY OF COSTA MESA — BUILDING PERMIT
ONNERSNAMEIFmmft TUCHMAN, TERRY F PERM NO: B 072600
ADDRESS: 1742 LERNER LN .
SANTA ANA,CA 92705 PERMIT NO: B 072600 PLAN CHECK NO: N GOVT : N SUPP ; N
APPL.MAILING ADDRESS CONSTRUCTION TYPE: PERMIT TYPE; STR PURPOSE: OTH
ARCHITECT OR ENGINEER: UC./At: JOB DESCRIPTION . T/OFF, SHEATH & REROOF W/COMP SHINGLES SQ FT : 2, 924
ARCH.OR END'S ADDRESS: WIT:
CLAIM VALUE; 2 , 924 , 00 CALC—VALUE: 2, 924 . 00 GROUP OCC : R-3 /
CONTRACToI'S NAME: STOUT ROOFING INC ( 310 ) 923-6775
CONTRACTORS MIRINGP 0 BOX 4309 COMMENTS: SMOKE DETECTORS ARE REQUIRED PER 91 UBC
DOWNEY CAIc w. 402536 ***+c**IEEE*afar•NSE**a***Et*****.c***�E*+a*+c*. :�E..K.*ua:car•+r***y:+.c.;E«+c**u+,Ei�; *x+E-k>�w-->Fw+l-a:s.c*.-*..<+
ADORE
90241 ZONINGN G REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penally dun,that I em licensed under p ens ne d Chador 9 SETBACKS
(commencing with Section 7000).of Division 3 d the Business and Proles s e.and my license la in full effect
car uc.NO.: 059377 9 ILSs: C 39 uc. 1025 16 Ei • 10 '95 MAIN BUILDING ACCESSORY BUILDING
/ ill
RNT; FT IN REAR: FT IN FRNT; FT IN REAR: FT IN
date 31 SIS Contractor: (v/ LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under perky of perjury that I am exempt from the Contractors Lice a Law I«Me
/ lolewnp reason(Section 7031.5&abets and Professions Code:Any city or ooumy whim requires a permit to const ,after.improve. PARKING REQ• P RO V; PARCEL : 41916406 Z N E: REF N O;
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 PLANNING NOTES>
is licensed pursuant to the provisions d the Contradors License Law(Chapter 9(commenting with Section 7000)of Division 3 of the ,
Business and Professions Cadet 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 net more than five hundred dollars MOOD. *****************it*****it******4***d(************iE****44*:f******cif***i-**44********
❑ I.as owner of the properly or my employees with wages as their vole compensation,will do the work,and the structure is not intended DEVELOPMENT SERVICES REQUIREMENTS
vI for enProfessions Contractors License Law does ownn e�lo an Owner of ha
Awho builds or improves thereon,ands/he does swork hmmH or herself or trough he or her moyee provided t� '
W.improvements are not intended«offered for sale.If.however,the building or improvement is sol within one yew dcompletion,the ZONING APPROVED BY DATE;
owner.buikler will have the burden of proving he or she did not build or improve for the purpose of sale).
1� I,as owner d the propend.ern excknivety contracting with licensed contractors to construct the project(Section 7044.Business and BUILDING APPROVED BY : �A __ DATE: _
ProfessionsctfCode:The ds with a License Law does not supy to en owner of property License L «improves thereon end whe ���//
o ofessio Som pros Co tra to s iceL)w gopunpply to the wner rspr ertyw Law).
lou /' I
❑ Iemexempt under Section: B.A P.C..for this reason: APPLICATION ISSUED BY : DATE:
*********,r************9r***********,. . *******1E****h*,.**************i>..test.. ***_
Data Owner: LEGALIZATION:N FEE SUMMARY STRUCTURAL SEGMENT;?
I do hereby certify that I am aware d and understand the requirements of California Health end Seiety Code Sections 25505.25533,and
25531.end that I or any Mure building occupant will/will net(circle one)need to cpmpty with said state codes end the requirements for y / GR 1 G
ES
a permit for construction or modificationfrom the Air tyyt�enag«nent District.Residential construction applications are exempt from these BLDG PMT PLUMBING ELECTRIC MECHANIC IRE 5T9IP, P,50 ADID.,>
provisions. PERMIT 54 , 00 , 50
SMIP/NON—RES
Date: Applicant: PLAN
WORKERS COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following dedaratens: ISSUE FEE
o I have e.nd will maintain a certificate of consent lo self-insure for workers'compensation,as provided for by Section 3700 of the Labor BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
Code,for the performance of the work for which this permit isissued.swo
TOTALS > 54 , 50 0 , 00 U , 00 54 . 50 54 , 50 00
I have and wit maintain workers'compensation insuurance,as required by Section 3700 of the Labor Code,for the performance of the
rk for whim this permit is issued.My workers'compensation insurance canter end policy number are:
bjAtI r. EXPIRES REVENUE DIVISION TOTALS--> COLLECTED • 54 , 50 OVER/SHORT- . 00
00 Pdcy Number. v+s y p y lir v v v�0 u r 10/19 /95 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
(This section need not be completed 1 the permit is for one hundred dollen 1001 or less.) 54 , 00 . 50
❑ I that in the performance work la whish thispermn' agree
shell not employ any manner,as to * **.Mir**************************#+t***********************+fire********?f****rf-****if*+
become subject to the workers'compensation laws of Califon. agree that I should barn disci to the woolen'
compensation provisions of section 3700 of the Labor Cod. I s ; -comp/'h those p• / INDIVIDUAL F E E BREAKDOWN
Date: Applicant: ♦
Warning:Failure to secure workers'compensation coverage Isunlawful,and shall subject an employer to crfml penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil lines up to ono hundred thousand dollars(5100,000),In addition to the coal of compensation,damages provided for In
Section 3706 of the Labor Code,Interest andatlomry'lees. SFR 2924 REROOF BY VALUE RESIDENTIAL NOZONE 1 , 00 2 924 , 00
• CONSTRUCTION LENDING AGENCY:I hereby affirm under penally of perjury that there is a construction lending agency for the END OF FEES
,
performance of the work for which the permit is issued(Section 3097,Civ.C).
LENDER'S NAME:
LENDERS ADDRESS:
I certify that I have reed this application and state that the above information is correct.I agree to comply with all city end county ordinances
end state laws relating to building construction and hereby authorize representatives of thia city to enter upon the above-mentioned properly
kir lnspectionpurpose9 r;RLENE BUR FORD/
nl Name r
a r / Bate: t .N/9C OAT001g3105/31/95- 018
3 -00183134: 11:42 TOT 54.50Signature of- .r/Agent'$$ee.L/Conuedor
(5151-46 WPI While-Building&Safety;Green-Ale;Canary-Appicanl:Pink-Revenue:Goldenrod-Assessor
'BOOL& SPA •� {
CONSTRUCTION AND PLANNING
APPROVALS Permit # Dat .f •spector' APPROVALS tl Permit # Date Inspector
ui'
1. Temporary Electrical Service or Pdle 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 tI
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE { r
� 1 .
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap;J 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 I 65. Electrical-Final
I
15. Rough Electrical-Conduit - 66, Solar System-Final
-
16. Rough Electric Wiring 67. Fencing & Access Approval : i
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 0Oil
23, Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing - • • - 73. Undergrnd.Storage Tank 0 Gas ;Oil
25. Roof Sheathing a-G. 94- IwL/ 74. Overhead Hydro
26, T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27, Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding _ I ' .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 rSSUED
- 33. Final Electric Notes:
34. Final Heating & Air Conditioning -
35. Final Gas PipecTest -
---
36. Hood or Canopy
37. Final Factory Fireplace
38- Final Plumbing
39. Water Se Fiiee: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 IC .4-qS
Act
48. FINAL PLANNING ` 7
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY ,
No. Date
PROJECT ADDRESS: 2335 TICONDEROGA WY UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 066774
OWNER'S NAME: TUCHMAN, TERRY F
POORESS: 1742 LERNER LN PERMIT NO: B 066774 PLAN CHECK NO: N GOVT: N SUPP : N
SANTA ANA,CA 92705
CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: REP
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : REPAIR CRACKED SLAB Y SQ FT: 800
ADDRESS: UNIT:
CLAIM VALUE: 800 . 00 CALC—VALUE: 800 ,00 GROUP OCC: R-3 /
PERMITTEE: JOHN DICKENS CONCRETE (714 ) 645-8345
ADDRESS: P ,O. BOX 1882 COMMENTS : NO OTHER WORK AUTHORISED BY THIS PERMIT
C.M. CA 92628 if****er*+t******e6*iE*erer******+serer*********+t*+ren+Ex**irerer*x**eH**eE*er*xeEetet*er***eHer***+E*+E**
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code,and my license is in lull force and effect. SETBACKS
CITY I.t 01 7 TEL• . 55981 CLASS: C
�ta ,� #—H--9_ ' 7 MAIN BUILDING ACCESSORY BUILDING
Dat /,,. • a — FRNT: FT IN REAR: FT' IN FRNT: FT IN REAR: FT IN
WO OMPENSATIONance,orDECLARATION: I hereby affirm that have a Certificate of consent to self-insure or a certificate of Workers'
Compe Pont Insurance,or a certified copy thereof(Section 3800,Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.: EXP.DATE:
COMPANY: PARKING REQ• PROV: PARCEL: 41916406 ZNE: REF NO:
❑ Certified copy is hereby furnished. 12c Certified copy is filed with the city Building Division. PLANNING NOTES>
Date: Applicant: *******************************************************************************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed it the permit is for one hundred($100)or less). DEVELOPMENT SERVICES R EQU IR E M E N 'T S
I certify that in the performance of the work for which this p slued,I shall not employ any person in n anner so as to become
subject to the Workers'CompensationpLaws of Californi person in ZONING APPROVED BY DATE:
�L Date: •11-1/ — ( Signature Y � ....-
` / NOTICE:IL after making this declaration,you should b e subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY DATE:
Code,you must forthwith comply with such provisio this permit shall be deemed revoked, C.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY
• DATE: 'I 1 I fti E.�
which this permit is issued(Section 3097.Civ.C). *********************fF******************* {Elf*{L.*.y.***.******.*.N.****** ****.*******,
LENDER: *******************************************************************************
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 21 . 00 50
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'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN SMIP/NON—RES
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). ISSUE FEE •
I. as owner of Inc progeny or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 21 . 50 0 . 00 0 .00 21 . 50 21 . 50 , 00
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 REVENUE DIVISION TOTALS--> COLLECTED: 21 . 50 OVER/SHORT: . 00
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). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 21 . 00 . 5D
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law). l am aware *******************************************************************************
that proof of their Worker's Compensation insurance should be provided to me. IND IV ID UAL F E E BREAKDOWN
❑ I am exempt under Section: B.8 P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner: SFR 800 ALTER BY VALUE RESIDENTIAL NOZONE 1 .00 800 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from
these provisions. ,
Date: Applicant:
I 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 construction and hereby authorize representatives of this city to enter upon the above mentioned
property for inspection purposes.
Date: signature: 01 00158757-00158758 TOT
DATE: 04/12/94 TIME: 15:21 21.50
Driver's License or Social Security N:
1641.46 While—Building;Green—Code Enforcement:Canary—Applicant:Pink—Revenue;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 Uiitity-Undrgrnd. 54. Forms r 11
4. Electrical Conduit'Undrgrnd. , - 55. Electrical Bonding
' 5, Steel Reinforcement L�(2.-9c' e 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. I 57. APPROVAL TO COVER•GUNITE -
7. Footings III L✓ 58. Electrical Conduit-Undrgrnd. '
16P--ice G g
8. Foundation I 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 {j
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 Il
20. Rough Factory Fireplace r :: - APPROVALS . Permit #
21. Duct's,in Structure
70. Underground Hydro
22. Ducts, Ventilating_ . - 71. Product Piping 0 Gas Doll
23. Gas Pipe-Rough & Test72. Underground Flush
24. Roof Framing - . 73. .Undergrnd.Storage Tank 0 Gas rJ Oil
•
25. Roof Sheathing 74. Overhead Hydro
26.- 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
•
1
33. Final Electric Notes: '
34. Final Heating& Air Conditioning 4- i 3-et L(- 4_A2 O /�. (
35. Final Gas Pipe-Test �Cte--/��
r
36. Hood or Canopy o . c _
37. -Final Factory Fireplace '
38. Final Plumbing : . • •
7
39. Water Service-Final . - -,
.40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer . -
43. Backflow Irrigation - - - .
44. Landscape Irrigation System . I .
.
45. Sound Attenuation • . -
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING u--(y-ety 6wt'
48. FINAL PLANNING - "
49.•Electric Release to Edison ,
50. Gas Release to Southern California Gas Co • -.
51. CERTIFICATE OF OCCUPANCY --
No. Date ,
vn"lall. bAIV VSbTA bUlLUSIVI,t CA/Finial' ""+•' 7 sr vl
JOB ADDRESS 2335 Ticonderoga Way • BUILDING PERMIT NO. 27533
GENERAL CONTRACTOR Same As Above DESCRIPTION OF WORK Residence W/Att. Garage
AP No.930.03-9 IAT 90 TRACT 5160 FIRE ZONE VALUE $ 18,114.00
INSPECTIONS Signature Date GROUP I & J TYPE V ZONE R-3
Soil lit.-_ q-ti-.c7 I PERMITS ISSUED
Gas //�q//��--�� SUBCONTRACTOR Date I Number I Signature
Water ft. /I,��T/� ."Y� 7 •lumbingA ,
Rough Plumbing �� l .S 'f.-2_0
-1fr .VOWsgflWWA7A AW0/0 at1'
Prop. Swr. Line 0 House Con.Q/- l"�-r /
Sprinkling System l�
Miscellaneous
Rough Heating and Air Conditioning 7k (O-2S-47
Temporary Service or Pole
Underground 0 Power 0
Rough Wir ng 4 -U /- - Heating and Vent.
Trenches Forms 2P7SIeel Reinf.. tft C_-ard 1 T T /.0--/ -6,1,7 Sia
Floor System - i j ii o '722/47
Bond Beam 0 Steel Reinforce 0
Sheathing 4 %
Frame and Flashing' �1 f( / �h
Lathing —In IL/ Out 0--- // /el
Plaster, Brown Coat ( / [�
Structural, Final ,' e- , l t.0p /
Heating, Vent., Refrig. and A.C., Final /h � -C rt(e�f ei, ei /o-3-67 A 777/
Plumbing, Final and Gas Test 0 /
Electric, Final p
Building, Final ' e- RS- 6
3 27533 ....'. ':9I .,I,
SEP 11 f 12. 00 3� 1 > „ .,.
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92620
For Applicant to FM In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
A . For ON&e Use Only
RU LOINS ADDRESS 3 3 Q' o.
ri
RECEIPT NO. PERMIT NO.
0COSTA MESA. CALIFORNIA R 13 RICE! D /
OWNER Tice: !////Jj1DCD
'-12-‘7^7
/
BUILDING
MAIL 1:21.-/til cADDRin .)O u60/�� e ADDRESS
CITY /O4A (i(.�'UM NO`oh-I nee ZONE /f J/
FIRETYPE !/ OROU
ARCHITECT
65
T0 77
APPROVED
Y
ADDRESS GD -21
70— yI c ZONING
DATE
ZONE ,�,I NO.or US[of NEW-W
�� , • ^Aw Q "ll FLANS 2 -BUILDING„/ &- /�
CONTRACTOR //��- .�-�l� 0A- I` "`///III y/I� ) /�e� /uy/' 4/•�UYL�
LEGAL
ADDRESS I /�U ww w+.{ DESCRIPTION r'-1C , / 0 Ti `eeke �i CS/0
CITY A-0v lA .(.2/ A.P.NO. /`3 0 — 0 3- 70
NOTE: NO RAVE OVERHANG SHALL BE LESS THAN
STATE TEL 90•TO SIDE a REAR p.L.
LIC.NO. NO.
EAVES
SIZE �J I NOW O ALLOWED (U.B.C.REQUIREMENT)
OF LOT h
YARDS APPROVED YARDS APPROVED
OVA
— MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG.
- (FROM C/L/STREET)C
SETBACK LINE FROM FRONT FT. FT.
CENMItow-STREEt REAR YARD �p
SIDE YARD LEFT 1 RIGHT 7 R.SIDE QUIT. FT.
DESCRIPTION OF WORK L.SIDE O Pr. PT.
ADDITION —
IIII I INEW ALTERATION T. BET.
MA.MREAR
N BUDGE. SLOGS.REPAIR MOIDEMOLISH
BUILDING .J n p NO.OF VAR.# DATE
SIZE J� c ROMS ��STORIIE/SI�� C.U..�PP•# (/�/ APPROVED
EXCOVERIOR ING
I ROOF COVERING �1 TYVC 0 FIh-1V[� t+/�• DATE 9-5—_�
COVERING /.
USE OF
BUI_LDI AND WO�R�IQ/TO BE PERFORMED l+T�yl W
CC ` o 1
J/3'/6 eQ.,j9�&v' 1
I HEREBY ACKNOWLEDGE THAT.I NAVE READ THIS APPLICATION THE AMOUNT • WN UNDER VALUATION IS FOR THE y
AND STATE THAT THE ABOVE is CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. ^Ij
PLY WITH ALL CI IN
RDA/CES AND STATE LAWS REGULATING VALUATION D
BUILDING COlip
•N.
SIGNATURECO OFPERMIT FEE $ D 07
PERMITTEE = A /lam` ��
S if/1 its
PLAN CHECK $ So — w
AUTHORIZED A-ENT r TOTAL FEE C9.0—