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Home My WebLink About214 21ST ST - Building Permits t t`� 9 CITY OF COSTA MESA r 66 BUILDING DIVISION f • 11 �,5 DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER j PERMIT -00539 aa,to V (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 214 21ST ST Status: ISSUED Suite No Applied: 06/24/2002 Vicinity: SIDE OF RESIDENCE Issued: 06/24/2002 Parcel Nunmber: 42614139 Applicant: BARRY, JAMES M ISSUED BY: Address: 214 E 21ST ST Phone: 949-646-0515 COSTA MESA,CA Zip: 92627 Owner: BARRY, JAMES M Address 214 E 21ST ST Phone: COSTA MESA,CA Zip: 92627 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 0 SCOPE OF PERMIT UPGRADE ELECTRICAL SERVICE FROM 50 AMPS TO 100 AMPS. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 ' Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 0 Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0 Switches $0.00 0 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $30.50 1 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $54.00 Intermed Pole $0.00 0 COMMENTS /SPECIAL CONDITIONS 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) DECLARA1 ONS 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. O 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'compensation Insurance carder and policy number are: Carrier: Policy Number: (This section need not be completed N the permit Is hued at one hundred dollars($100)or less.) . <CZ I certify that in the performanc: - ''w•rk for which this rmit is issued,f shall not employ any person in any manner so as to become subject to the workers' compensation laws of Call• a,arid .greet t If I sh become subject to the workers'compensation provisions of Section 3700 of the Labor Cade,I shall forthwith comply with these pray':ons. Applicem:SIgnature: Date: b/..2zq a Z WARNING:FAILURE TO SE URE W'KERS' PENSATION COVERAGE IS UNLAWFUL SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIE AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,Oco),IN ADDITION TO THE COST OF COMPENSATION,DAMAGE AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is In full force and effect.Lic.If Class# Contractor's Signature: _ Date: 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). Lenders 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 property,or my empfoyees 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.). O I,as owner of the properly,am E •NTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors Lice - aw does not apply •an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) se pursuant to the .•• actors License Laws.). 1 amexempl_u •,• -yc Business and Professions Code for this reason: Signature:'- GDatac---. (---y02.WO Owner ID verifi:d by driv- s lice e. Yes 0 No DriYer'S:Ctcense No.- � ( ( plr ,Exes,�/7G176 Verification of Owner- ip b e of doc et,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: O 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: 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? 0 Yes 0 No (Section 25505 of the Califomia 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 Califomia Health end 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 o1 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 Califomia 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 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? Yes 0I No (Section 65850.2 of the Califomia Govemment 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 Califomia Health and Safety Code Section 42303 been made? 0 Yes ❑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 COMPIJ-• AND AUTHOR • •N 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 co •• th state laws and ci ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described y for' pection pure• - .• :: • •occupy or allow occupancy of any building authorized by t is permit until final inspection. l/ `Signature:Of:Legel-0wner(s)--_..� �G�/CDa And/Or Authorized Applicant Date CODE I IISPECTION TYPE PEES It1IIDAL5 CODE! IN5PEC110NTYPE PALE INTRULS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1286 Pool Spa Final 208 Final Plumbing T 200 Final Re-Root 210 Final Electrical I II 471 >j" /YwY'4'-Y 201 Final Block/Retaining Wall 212 Final Fire Prevention /pp (f 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy PTHIS PERMIT IS ISSUED COUNTY OF ORANGE SUBJECT TO ANY FEDERAI BUILDING DEPT. -- R1.. STRI ION - Permit N:3 ✓ Si636 No. Broadway Application for building Permit Santa Ana, California Phone: KI 2-6211 AND FOR A Certificate of Use and Occupancy Date-_ ((JJ(( �� ry// 1. OWNER'S NAME ��df��` /��,y PHONElb`tJ -76.11--- MAILING A-7 MAILING ADDRESS----7 7 eiC�i M-. //!ti CITYtatfr. 7........... Name Name,r444/27 (Architect or Engineer) ( o <tor �� Address - _ Address C/Y�f�,/t�� City------------------------------------------ --------------------------------------_- City -��,(/ — >(-4"t---- State O _ /� State State Q Y '3 F( ,s- /yd 51 Lic. No. Phone Lic. No. .Q Phonel�LGfC. e7 PROPOSED USE: er 74,!,,,,,,,,,..4 --% 'y / 2. JOB LOCATION �{ �:��--yy//- �r r '�-r� tar. (House N z)d SW /e tYa�Qf't 4 e -E4 '4 ' Iw•-. ;.A War. -- Z19. 3. LEGAL DESCRIPTION: Lot 2 s� `� j ck (Metes and Bounds Description—Use reserse side of form) 4. CORNER LOT ( ) INTERIOR LOT (V) THROUGH LOT ( ) SLOPE OF LOT (- ) 5. SIZE OF BLDG.: _�K '3..OAREA• 3 3 s D&SIZE OF LOT• INf X /0 a AREA-/j �. ' O 0 6. HEIGHT OF BLDG.: Ted- CEILING HEIGHT: ailtd NO. OF STORIES erne-- 7. NO. FAMILIES [1�L Sizz/qee/�of _Smallest Bedroom: _./ ,c // Size of Kitchen: _7X 10 8. EXTERIOR WALL CONSTRUCTION:/1 INTERIOR WALL COVERING/ ix_ (Frame, Stucco, Etc.) `` (Plaster-Drywall, Etc.) 9. SETBACKS: Front Yard from Center Line of Street V�d Nearest Side Yard /3 Rear Yard._0 Distance in Feet Between Bldgs. on Same Lot 10. A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STRUCTURES AND USE OF EACH. N J b II. For (a) Footing: Width /54" Depth in Ground /z Width of Wall "---------- Accessory l` rBldgs. and (b) Size of Studs: 2x f Spacing /‘ "CC Material of Floorea Similar Structures: (c) Size of Floor Joists: Spacing _"CC td) Size of Rafters: Spacing _ "CC 12. VALUATION OF PROPOSED WORK: Including all labor, plumbing, electrical wiring, heating, fire sprinklers, paint- ing and sewage disposal $ ....5-7.7:3r- - 13. I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN THIS APPLICATION IS CORRECT AND THAT THE CONSTRUCTION WORK WILL CONFORM TO ALL LAWS OF THE COUNTY OF ORANGE AND THE STATE OF CALIFORNIA APPLICABLE THERETO. • / Signed:O "' • / Plans Filed )--g (Owner). By. (Authorized Agent) FOR DEPARTMENTAL USE ONLY FEES: / CH KING BY Bldg. Permit - $ /'7` �� GROUP C APPLICATION HEALTH Plan Check - $ 3 av TYPE ZONING FIRE Total - $ l7 __ DIST. MARSHAL G j J' MAP PLANS AND Receipt No. - - ____—__-__ __rr_ SPECS STATE Paid to Q _____--- SHEET NO rCORRECTIONS ENGINEER Date 7' •,y-�L __ _______ VERIFIED CAL - COUNTY By:I DING PERrMIT�ISSU• ED:BVild[ Nsr QCT )H DATE -- -P :7.- --- Cm • ' METES AND BOUNDS DESCRIPT1 Flo z103�oa�or�o eo 11 11111111111111. 1111111111111111111111 1111111111 WI Thum nammMOM=MMIIIM=ONEMMMEAMmUMMIMMOIMAMMEMMMIEMIE 1= ■ IIIIII I- - II IIIIIIIIIIIII III mm maim mom mm IIII�1� �� -1. 11111111111111111N 11111111111111111111 111111111•111IT mi mmommmmommEmmomm mm =mum= EENE MEN NmEENNEMMM_ • MMINIMMEMMEMMEMEMEM NM MOW= NM MO MMEMMOMME 1 II I 11111111111111111 111111111111111111111111111111111111 - MEME aAom �=I nu allIMOMMOMMEMMMIMMEMMEM MMEmmEMmm.MMEMMIIMMEMEM.A ammm i�,�s� 11 111111111111111 11 111111111111111111111111111111111 : II _X ME MMOMMOM OM Me =EMMEN= XMEMMEMEMMOMMEM MI MMEMOMEM MI MINNOMIIMMEIN ommommmommomommo ' •iia '° i�MEMI � ' .111.."1"""."1". 11111111111111111111111 11111111 1 1 1111 119111111.111 •••••••••••=1MMMOMOMMEMEMEMEMIE A mmEmommem _ MMIIM 111111111111 11111111111111•111111111111111111.1 MMIIMMM N 111111111111 111 1- 11111119111 1 1111111111.11 11111- -I 11111111111111111 1 1111111111111111111111111111 il II' C 1MMMEMMOMMEMMINIIIIIIEIMM ilk II 11111191111111111111 IIIIIIIIIIIIIIIIIIIIIIII IMAM - III al 111 111111111111111111 N11111111111111111111111 110 1MM - .MEMN EMMEN= MEM MN MENEM MOM ME • EMEMEMEMEMEMOMMOMOMMEMM rn.mm11111111111111111111111111111111.11111111111111111.1" MN � IM 11111e � ais e � � = -w MEM � °i ai �i�e� ems O OWNER BECKETT, VIOLA M. DATE 1-23-57 JOB ADDRESS 214 E. 21st Street BUILDING PERMIT NO. #4232 GENERAL CONTRACTOR Owner Bldr• VALUE $ 350.00 L` APll8-1 10-26 BLOCK TRACT N Fireplace 253 ewport HEtS. GROUP J TYPE III ZONE FILL FIRE DISTRICT 4276 INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED DATE NUMBER Footing Trench �' I -0/ /n Foundation Forms and Grade to Garage 4/ �� ,G2./ Rough Framing / , ,t I. "'� V r Plumbing,Rough to Slab Plumbing, Rough Complete ilarMar Temporary Pole fnagili111111r/ / i Wiring, Rough V' r ‘ Heating, Rough1 Or Heating, Final --- i�' n v i Sewer, House Sewer,St. h Se-'ic Tank or Cesspool L ng, In Out Plastering Plumbing,Final,Fixtures Complete _ Plumbing, Final Gas Test Wiring,Final _ Occupancy Aid //_e FORM 210 3M 10.55 b:32 4232 I JAN23 " 2 .00a . 5750 00 a. 4276 COSTA MESA BUILDING DEPARTMENT P.O.BOX 317 COSTA MESA. CALIFORNIA FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT Aoo EIss o7 / `i 67- oil- ( �x - BUILDING COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY -- / J IJl/. TJJAS. .9• >' • Go_., h T RECEIPT NO. �P/ERMI T 3 N A OWNER ., MAILy( ['Lq 4* ..--2 RECEIVED BY DATE RECEIVED DATE ISSUED ADDRESS a I - 11 • q. •n --t--,--/2/ /0R 7-C7 t `r..Z3 CITY l� ,�, TNO.&rp _ I.1.y.fi ADDRESS ARCHITECT L LIC. COSTA MESA. CALIFORNIA OR ENGINEER ��.yA� NO. . FIRE AO0Ft _d /ni / ZONE CITY LIC.N ZONE IS PLOANB TYPEGROUP CONTRACTOR• �^ y,,, NO. ] A� / /= ADDRESS LOV.(ti j 4a.&6� NO.�8- �J 6 /i- gPPROVE ;+f PATE / LEGAL l 3 TyrJy V / DESCRIPTION NO? 5 BLOCK r TR, / APS' EV gb A.P.NO. 118 --/ /0 — 6 QIIIJ SIZE NO.OF BLOCS. CITY OF COSTA MESA i OF LOT 13 X I ,ti NOW ON LOT I PLANNAC DEPT. USE OF / SUBJECT TO LOG. DEPT. REG. EXISTING BLDG.rR.�L-d,�t•i.A.4-0--. SETBACK LINE FROM {{{{I��L� �J .Q� 1j /'1 J� CENTER OF STREET J 0 REAR YARD I, Tr• p �//A�II I//r -.23-`9 / V LIYY' Tr I f ` T SIDE YARD RIGHT ty / LEFT / :5- PLAN C DESCRIPTION OF WORK X NEW _ALTERATION • I ADDITION (� REPA... MOVING AI DEMOLISH BUILDING NO.OF SIZE ROOMS STORIES EXTERIOR WALL ROOF .COVERING COVERING USE OF NEW BUILDING I t...14 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL CITY.ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUC- TION. VALUATION T� SIGNATURE OF )'VL 4 .r�.,,fir • � �idt PERMIT FEE $ y/ PERMITTEE Ir V[f�i 3AS CO-- .- PLAN CHECK $ — AUTHORIZED AGENT TOTAL FEE 5 �� — 414r ''':',‘'.1?' 'I"* . • % , ,Al. r .., . . .I • -.1 t-4' .: wt :. • • • • • - 3 > ij •• ;rel - .., • -: �.. .. . . . . 4 -a r• . . ,,1 t 0%. . --r.-----, . • • c • c'�� - • • • G OWNER REGAN GEORGE DATE 3-29-68 XJOB ADDRESS 214 East 21st Street BUILDING PERMIT NO. 28393 GENERAL CONTRACTOR Owner-Builder DESCRIPTION of WORK Detached Garage 5;;;'µo. 118-112-03 LOT 253 TRACT NptgtgtIRE ZONE VALUE $ 1.240.00 a-i>"'ECTIONS Signature Date GROUP A TYPE TI ZONE 171-1 SOIL SUBCONTRACTOR PERMITS ISS ED GAS Date I Number 1 Signature WATER Plumbing ROUGH PLUMBING PROP. SWR. LINE Q HOUSE CON. fl SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND ❑ POWER ❑ ROUGH WIRING Heating and Vent. TRENCHES ❑ FORMS 0 STEEL REINF. 0 3 . /r�� FLOOR SYSTEM rA a (/ BOND BEAM n STEEL REINFORCE n INC bpi - glp r FRAME AND FLASHING LATHING - IN in OUT n PLASTER, BROWN COAT S TURAL, FINAL Flectric ML...ING, VENT., REFRIG. AND A.C., FINAL (,�-(,✓—r.li.L/'� / yn� /J/)� // 2t4tc r/ PLUMBING, FINAL AND GAS TEST n carte-AA- ce . 79 ti 2q874 ELECTRIC, FINAL ��i`l' r V" BUILDING, FINAL .:% L% //,'J.ra/6y 28393 - nne 29.6 852* ****13.50 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING For Office Use Only y AD24 21k EAST 21ST. ADDRESS DREES RECEIPT No. Qyeff NO,� C. COSTA MESA, CALIFORNIA T[ - 'IVDr DATE I'O[D (. • OWNERGEORGE E. AND BERNEICE REGAN , it—�' "0 di ,. BUILDING MAIL p// 7/[y�7. Iv • ADDRESS BOX 20 6 ` ADDRESS a / V• 4 . S FIRE ' cITYCOSTA MESA •2626 NTuLO. L18 2 1 . ZONE TYPE I ' GROUP APPROVED r` ARCHITECT NONF TEL • BY �f"I DATE 'NW ECT /JMJ. ZO NG II .'. ADDRESS - • Z• E NO.OPr2,./..' / USE OF NEW PIANS 'v I;BUILDING 1i y CONTRACTOR OWNER ., AD•REEFDESCRIPTION V 5" 1 ,i„, / .Lr. ^ '/ r w � • CITY A.P.NO. / ( 2^ Inc)- - o_3 NOTE: NO HAVE OVERHANG SHALL BH LESS THAN STATE TEL. SO•TO SIDE a REAR P.L. LIC.NO. NO. VES . SIZE NO.OF SLOGS. ALLOWED (U.B.C.REQUIREMENT) -. OF LOT 75 X 100 NOW ON LOT 1 APPROVED YARDS APPROVED 1' YARDS ,, USE OF MAIN BUILDING ACCESSORY BUILDING n EXISTING BLDG. HOME / SETBACK LINE FROM n 1 Q/ FRONT FT. 4 O I' CENTER OP STREET 109 REAR YARD / Di SIDE YARD I LEFT 5501 I RIGHT 5 1 SIDE �FT• DESCRIPTION OF WORK L.SID PT. A Fr. I • X l ALTERATION ADDITI•N e FT. BET.MAIN P." miury BLD r ACCESS.BLDGS. REPAIR MOVING •HMOLISH vAR.* DATE Y' SIZEBUI 16 Yi 20 NO.OF ROOMS 1 STORIES' APPROVED • EXTERIOR WALIPLYWOOD I ROOF /1 +1 COVERING COVERING TARPAPER - • I 4 L. 1 ,_DATE .J ° USE OF BUILDING AND WORK TO BE PERFORMED - a '. GARAGE 51 ; 11.1 1 .' �� "�SQ.FT. 0 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THEE AMOUNT SHOWN/DER VALUATION IS FOR THE j AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM• PURPOSE OF [STAB//-KING A PERMIT PEE ONLY. N. PLY WITH ALL CITY ORDINANCES AND STAT[LAWS REGULATING VALUATION - BUILDING CONSTRUCT N. 7co ,!. PERMIT FEE • SIGNATURE OF Jc+ '' PERMITTEE '�^ 7'ti. ^ $/ � � -.• .SII k AUTHORIZED AGENT � J Sa ...�. -- .: > _;. .. ,.. TOTAL FEE $ I