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HomeMy WebLinkAbout277 21ST ST - Building Permits 277 21ST ST„ ' CITY OF COSTA MESA — BUILDING PERMIT /� 97 - DOf�j (o ADDRESS a BUILNNo: 25x7: OmJER'SNAMElcaawN:COHEN, STANLEY " PERM NO: B 086369 t*AODCss:COHEN RAE A 1501 ANTIGUA WAY PERMIT NO: B 086369 PLAN CHECK NO: N GOVT: N SUPP : N '( NEWPORT BEACH,CA 92660 APPL.YOUNG ADDRESS CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: OTH ARCHITECT ORDIMES: • LIC.MO.: JOB DESCRIPTION : T/O & REROOF W/COMP, SQ FT: 3, 250 ARCH.OR ENG.'S ADDRESS: UNIT: ' CLAIM VALUE: 3, 250 . 00 CALC—VALUE: 3, 250 . 00 GROUP OCC: R-3 / LroNTRAcroWSNAStFAIRWEATHER ROOFING ( 714 ) 832-5357 CCNTRACTORSMAIUNG 3845 E CASSELLE AVE COMMENTS: X ADDRESSORANGE CA uc.NO.: 515125 '>E**icih3t3Eititif7P****ikitiflf3tlPiElfiEiEiEiF3tiEi4lf* 3ElfittE#3EiPit***t4jkiEiPiElEiEiEjE1EiF#1f*i(iPjEitlE*rtit******1H1f3ftE*** 92669 LINT: Z ONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby[flim under penaly of perjury Drat I ani licensed under provisions of Chapter 9 SETBACKS (corn h Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force end effect. (C LIC.No. 47 28 LW.CLASS: C 39 LIC. 515125 EXP: 07/98 MAIN BUILDING ACCESSORY BUILDING Date: l Contract«: FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN �� `tiC /� LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWN UILDER OECLARATION:I hereby affirm under snaky of perjury that I am exempt from the ConM«°License Law for the ion g reason(Section 7031.5 Business and Professions Code:Any city or county which requires a permit to construct,eller,improve. PARKING REQ: PROV: PARCEL: 42621507 Z N E: REF NO: demolish.or repair any structure,prior to les issuance,also requires the applicant for such permit to file a signed statement that he or she j%-<7 licensed pursuant to the provisions of the Contractors ucanae Law[Chapter 9(commencing with Section 7000)of Division 3 of the PLANNING NOTES>(- ..,,usiness end Prolessions Code)or Mal he or she is exempt therefrom and the basis for the alleged esempun.My violation of Seden >.) 1;031.5 by any applicant fora permit sheds the applrant to a civil pemhy d rwl more than lee hundred dollars[$500D. 1E 1P lid lE lE lE lF ill lP lid It#1F!(-1k lE lF 9E IE ill ft IP lF lF lP did if lE lE ill it#lE It ll9t iP IE 3E fid 1E#1l1f dE It ill lE ill df 3k 1E 1f ill dE irk dE dE#fE ill 1E 1E 1E 1E f(•1E 1E 9E 3F If M IE ill ill irk lid did ill ❑ I.n owwer'Alba property«my employees with wages as their ode compensation,will do the work,and Ile structure is not intended D E V E ;L O P M E N T SERVICES REQUIREMENT' S or offered for sale(Section 7044.Business and Professions Code:The Contractors License Law does not apply men Manor of properly who bold°or improves thereon,and who does such work limaeif or hersen or through he or her own employees.provided that such .. - irtprovemanfs are nod intended or cifiered for sate,if,however,the building or improvement is sold within se yew of mmpetcn,the ZONING APPROVED BY DATE: owner builder will have theburden of proving he or she did notbuild or improve torthe purpose of sale). ❑ Las owner of the propend,am exclusively contracting with licensed contractors 10 construct the prged(Section 7044,Business and Professions Code:The Contractors License Law does not apply wan owner of properly who builds«improves thereon and who BUILDING APPROVED BY : DATE: contracts for such projects with a conlredor(s)licensed pursuant to the Contractors License Law). ❑ lemmempt under sedo : B.aP.c..f«Nlemeson: APPLICATION ISSUED BY: / DATE:/ SI y 3H 3H 3H 3H 3H 3E 3H 3E 3F 3H 3f 3E 3E 3L 3H 3H 3H 3E 3E 3t 3H 3H 3E 3E 3H 3E 3E 3E 3H 3E 3f 3H 3E 3E 3E 3E 3E 3E 3f 3H 3E 3H 3F 3H 3E 3E 3H 3F 3H 3E 3f 3H 3E 3E 3H 3E 3E* 3E 3H ** Date: Owner: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT: Y I do hereby certify that I am aware of and understand the requirements of Callornia Health end Safety Code Sections 25505,25533.end 25534,and that I or any future building occupant will/wit not(circle one)need to comply with said state codes end the requirements for a permit f«mnWdian or modification the Ai3i ly ampemem District.Residential mrdmdm°pplicai«w are exempt from these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING provisions. PERMIT 87 . 25 . 50 Date: Applicant: SM I P/NON—RES WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of ry perjuone of lit following dederstbn: ISSN ISSUE FEE o IoeveandWerrmaccofthew kforwnihthisprareawued. mpensetion,nprovidedfabySemco3]OOdihlabor $UILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE cede,r«tneped«mawedu.wdkr«w:nmapemivesed. TOTALS----> 87 .75 0 . 00 0 . 00 87. 75 87. 75 . 00 ❑ 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 a Sued.My waken compensation insurance miner and policy number are: Carrier: REVENUE DIVISION TOTALS > COLLECTED: 87 . 75 OVER/SHORT: . 00 Potty Number: BLDG PMT PLUMBING ELECTRIC .MECHANIC FIRE SMIP/TOT GRADING PLAN— HECK is section need not be completed/the penal is for one hundred dollars(5100/a less) 8 7 . 2 5 , 5 0 d L] 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 subject to the workers'compensation laws o Caldane,and agree that N I should become subject to the waken' .***.***************************IL.***********.******.1(*******1f******.***M*3f*********. ion d Seaton 3700 d the Labor Code,I shall fo with corn prmnstma. _ INDIVIDUAL F E E BREAKDOWN .. .. i ppnV Applicant:II `� Ing:Failure to secure workers'compensation coverage Isunlawful,end shall subject an employer to criminal penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST civil OMs up to one hundred thousand dollen(5104000),In addition to the cost of compensation,damages as Provided for In Section 3705 of the Labor Cods,Interest,and effomeys fees SFR 3250 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 3, 250 . 00 CONSTRUCTION LENDING AGENCY:I hereby affirm under penally of perjury that there b a construction lending agency for the END OF FEES pedonnance of the work for which the permit is issued(Section 3097,Civ.C). LENDER'S NAME: LENDER'S ADDRESS: I certify that I have read this application and stale that the above information is coned.I agree to comply with all dry and county ordinances and state laws relating to building conmrudion and hereby authorize representatives of the rely to enter upon the above-mentioned property for inspection purposes. SCOTT ALLISON a1 7.2-:99:/ 9:44 h bt97.75 Print Name r p KERN:i:1 i:17.s,•.G Date: (/Z�70 PERMIT c086369 b/ggnature of Owner/AgenVAppbcan a (5151-46 WP) White-Building&Safety:Green-Fle:Canary-Appicant:Pink-Rerenm:Goldenrod-Assessor CI ttSTRUCTION AND PLANNING -I POOL , -PA APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector lk 1. Temporary Electrical Serviceor Pole 52. Pool & Equipment Location . 2, Soil Pipe-Undrgrnd. . . 53. Steel Reinforcement , 3-r- . • 3: Electrical Conduit-Utility-Undrgrnd. 54. Forms '.4; Electrical Conduit=Undrgrnd. 55. Electrical Bonding -- . .. ,5: Steel Reinforcer~f ent 56. Rough Plumbing & Pressure Test • 6. Electrical UF ER Grnd- 57. APPROVAL TO COVER-GUNITE „7. Footings - 58. Electrical Conduit-Undrgrnd. - • -a-8. Foundation - - 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undfgynd.L - 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 ' 14. Rough Plumbing -1 65. Electrical-Final 15. Rough Electrical-Conduit • 66. Solar System-Final 1 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 - - E 'D lREEPT'REOUIREMEN-T _ -. _ .. .. - "-. - -._�_i 20.`-Rough Fa'btory Fireplace - 'i' •- APPROVALS r Permit# _r _ 21.i ucts,in1tructure. _ - tD 70.,Underground Hydro • 22.`Ducti;, Ventilating; ,. 5, 71. ProductPiping.cl Gas 0 Oil -, 23. Gas Pipe-Rou &test _ c 9h R 72. Underground Flush 24. Roof Framing .x? '.., _ 73. Undergrnd.Storage-Tank 0 Gas D Oil 25..Roaf;Sheathin g - l=-&.-2g. • 1 74.-,Overhead Hydro•; _ _ - 26. T-Bar•Ceding (Structural) & Monocoat v O a - E 75-pry Chenical :'a '` 27. Frame and Flashing` • J ` 76. Dry Standpipe..1 - 28. Lathing&Siding i , _ S r 77: FIXED SYSTEM'FINA4L ' � -y 29. Insulation _ 78. FIRE PREV, FINAL 30. Drywall Nailing . l•., ' r. i t " S =HEALTH DEPT. REQUIREMENT 31. Plaster Brown.Coat '' " x hi.. ' 79. FINAL INSPECTJ.ON , _ 32. Electrical Power Meter-Final - v- 8_0 FOOD CERTIFJCATE ISSUED' ': 33.-Final Electric ,• z '' I l Notes: cr. - :; , ,• 34.'Final Heating-& Air.Conditioning- r I v, - �,- V 35. .Final Gas Pipe:Test" ' - -- -.`0 .1: .im to ti it 36. Hoon or Canopy - ,+ ` ^'� to _ r 37. Final'Factory FirepCace, = - -...f4: v, • 38. Final,Plumbing 1- . � - •- 7 ca 39. Water Service-Final , T - 4' r _ .- . . • 40. Gas Service-Final , F_. a �., �,s; . 41. Solar Domestic-Final 42. Backflow Preventer .. .J- r• 43. Backflow Irrigation '" - _ _' i 44..Landscape Irrigation System-F:' t - _ _ , j _ - , • 45. Sound Attenuation- = 'r ' to ' . __ ' ' ' 46. Handicap Regulations ; " " • -47. FINAL STRUCTURE & BUILDING r/ l • L '� .. AS 48.,EINALPLANNING` s 1. .r, • 49. Electiic Release to Edison r. 5 .50..Gas-Release to Soutfiern California Gas Co ' - • 51. CERTIFICATE OF OCCUPANCY " No. Date UWNtK MTI STER, GENE .UAIt v-25-77 JOB ADDRESS 277 East 21st Street BUILDING PERMIT NO. 43782 GENERAL CONTRACTOR Sun Boss Corporation DESCRIPTION of WORK Patio Cover AP No.188-143-06 LOT Por.244 TRACT 4115 FIRE ZONE VALUE $ 1,120.00 I' 'ECTIONS Signature Date TYPE IV GROUP J ZONE Ft]. S` • PERMITS ISSUED GAS SUBCONTRACTOR Dare I Humber I Signature • 1 WATER Plumbing ,ROUGH PLUMBING t,PROP. SWR. LINE El HOUSE CON. El 0.V.�,'S SPRINKLING SYSTEM MISCELLANEOUS • -.."ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND El POWER 0 ROUGH WIRING Heating and Vent, TREPArrI STEEL REINF. I I FLOOR SYSTEM • BOND BEAM n STEEL REINFORCE f SHEATHING FRAME AND FLASHING LATHING - IN n OUT n PLASTER. BROWN COAT STRUCTURAL. FINAL Flertric NG, VENT., REFRIG. AND A.C., FINAL P. SING, FINAL AND GAS TEST n ELECTRIC, FINAL �/ BUILDING. FINAL tin ,s- `"a? SPFCIAI REOIIIREMENTS .i- f 43782cl,, —8-,71:5=on 37' *;"*.•111.5( . COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely ����///��� -7 r 1 C L / TI /y] RECE/yrELp�/I DATE RECEIVED O rE " ADDRESS Z7 E �ti ?h 57 [ Osla///Q-Sa REC)�~{LL� 79 , 'PERMIT N07T OWNER nano &esteem A.P.NO.//g- �yJ ` ©( MAIL / yy// 1 BUILDING Cay ADDRESS / C . th 'e/ ADDRESS Z11 F PO _� fl. W W /�.t ,, TEL ,I�s TRACT yIf15' PO rrovy C.U CITY (.nsta Tht!sa NO. 5'r07b37 LOT Z4 BLOCK ZQ CONSTRUCTION NEW ADD ALTER REPAIR MOVING OFMOI ISH Ocn LENDER v a. m C _l D BRANCH / —I CO OWNER 6e nor m E e5fer 0 ADDRESS 1 yyjgVALUE /� J ARCHITECT 1 JJ TEL. USE Pa*1n CnIW1 Ili �Dfrle $ 1102U•OC., OR ENGINEER (Jo h nsnn 4 N ielken NO. YI�J// U La FIRE Z Q ZONE TVP GROUP S W L ADDRESS n-w /� 1 APPROVED til CONTRACTOR �I)n I"Joss l'nrpnra l /nn BY DATE 877-, J Q CO :Jr, ADDRESS IiEA sfa0y N){9T1 ZONE / NO.OF USE OF NE RcbrV Z(- CITY Riuersi ee. NO.lp lb86 p` PLANS Z BUILDING .Q COOce IL O STATE CITY Q YARDS APPROVED YARDS APPROVED in CC LIC.NO. ,: 101:).1 4 LIC.NO.On 03 Q 1 MAIN BUILDING ACCESSORY BUILDING D O (FROM C/L STREET) SIZE NO.OF BLDGS. !'/�y� OF LOT 1t I NIOW' ON LOT I FRONT. �r�OCFIV. "L FT. Tv Pt EXISTING BLDG. r r I V a 1 e Iwe`I' 'Ica.- R.SIDE 41 � 'FTT, FT, I— SIZE OF NO.OF Z NEW BLDG. ROOMS STORIES L.SIDE/477;4 FT. Q EXTERIOR WALLROOF >— nhey i C.1 COVERING I COVERING REAR 2%/C/ FTt.. nL.. FT. —I USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& r Cn P (.20' X 110/ oC-rmQ.ene ri _ MAIN SLOGS. ACCESS.BLDGS. aluminum Fa+1& Pl1Ue.r C.U.P. APPR ATE O C.U.P,qfS APPROVED I— APPROVE2 fn _BY DATE DATE �� V-'7 / Z 0 , VI hereby acknowledge that I have read this application and state D that the above information is correct and agree to comply with all laws regulating building construction, and I shall not employ F ony person in violation of the workman's compensation laws of y the State of California. 3 7 GLV w 0 zI hereby certify that I am properly licensed as a contractor under SO. FT. o the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR i Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: a CC am exempt from the provisions of the State of California Business and Professions Code,Division 3,Chapter 9. VALUATION 00 /2.00 m PERMIT FEE $ ` w 3 Signature of C a '' II /////� Jf 0 Permittee 01)n 8055 1)�1f p` /\ O $ il� PLAN CHECK �,OV E Authorized Agent I (� •SO a TOTAL FEE $ /g Sa ori a OWNER POPE, MAX W. - - / DATE 5-13-55 ' a) JOB ADDRESS P77 E, •21st St:" V BUILDING PERMIT NO. 1308 GENERAL CONTRACTOR Max W. Pope VALUE $ 10,824.00 • L . AP# 118-140-22 BLOCK TRACTnn���� Residence & attached garage GROUP I TYPE V ' ZONE Rio FIRE DISTRICT (C) 1323 PERMITS ISSUED INSPECTIONS DATE + SUBCONTRACTOR C� ��f. DATE NUMBER Footing Trench cfcs _ Foundation Forms and Grade to Garage �l.� Rough Framing r/�'- Plumbing,Rough to Plumbing,Rough bGComplete oKY ` - / I �'l- _Sr , . C . _._J G - 1-SJ • Temporary Pole ZGe-p�`l-- — da 55%/G - Si Wiring, Rough 2e-e-, aet-ec -i, y r , -/a -S3 /176 Heating,Rough Heating, Final %,l&Aes,,, 5r h,JJ2 n_g_c f ,,'pit Sewer, House- Sewer,St./ Xcet /4-(-;-, /4I, ems„ 7--/)--CC a r Septic Tank or Cesspool L ,1g, In Out Plastering Plumbing,Final,Fixtures Com. -t- 0 Ditil Plumbing, Final Gas Test/5r MPIr i- -J M Wiring,Final i/ 1/- '1100 dr0 W Occupancy )a-06 • -_V J) 1:nrn,9111 G_H 19011 1_SS scosta Mesa Building REST Department /3 ) ?PLICATION '� r "r" 111 EAST 20th STREET .V , COSTA MESA, CALIFORNIA tie' FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY Receipt No. I %erml6Ncii Y Building D��// Address 277 E . 215 t Received by 1 Date Recd. Costa Mesa, California Nearest • �IDate Issue` AY 1 3 i955 Cross St: 'Santa Ana Ave Building Address Owner Max W. Tope - Costa Mesa, California Mail Address 407 Bolsa Ave Nearest Tel. Cross St. / city Newport Beach N0LI 8-2281 Zone, I PlansNo.of I Typq� I 3 19: Architect or Lic. /�'-" vVVV Engineer No. Approv d by • Date Address CORRECTIONS City go,. ,/�� tractorLlaX W. Pope No. 1513 �`i�" 1� Address - u a *"` LegalLot • •^ Description I No. Block I Tract '- (Attach Metes and Bounds) ( Over ) No.of Bldgs. Size of Lot 60 x 120 I Now on Lot 0 ' 0 Use ofNo.of No.of ��''�� z Existing Bldg. 0 I Families I Rooms �+�j lb__L) Setback Line from Rear Yard 30 r Center of Street 50 t Side Yard 5 1!.i y DESCRIPTION OF WORK . . r .:;' f� lah5 New I X I Alteration I I Addition I - RepairI I Moving I I Demolish I CITY OF COSTA MESA Building No.of Size 1352, Sq t Rooms 6 Stories 1 F--`prior Wall I Roof _ :ring Stucco I Covering CoinpO APPROVALS t...e of New Building )1Q5 & attach'd Gar , Foundation Location Inspector Date Forms,Materials, Under-Pinning n Frame: Fire Stops, ro Bracing,Bolts ry VI n I hereby acknowledge that I have read this Application Lath. Int. ca and state that the above is correct and ee to comply Lath.Ext. i 929112with all City Ordina and State • s regulating building construction ri.'r' �_ Iri Signature of Plaster, lit. ,,," � Permittee Cir" o a Plaster, Ext. a co Ni Authorized Agt. O Masonry Reinforced * l Valuation �� Permit Fee $ !G= 1 j r,• //\\ Plan Check $ j Bond Beam Cl :` $ V Total •y 7 J Fee $ _/ FINAL "i HI rORM 204 G-H 2M 0-54 C'] U • • 44 4 C N . • a' Jr - _ •. a o The Se ' ly 60.0 ' of the Nw'ly a. .522 ' of the Ne 'ly 120 .0.' of lot 244 Npt Hgts , • fr r til .U'.,.. . •1 . . Street - :rn PLOT PLAN Show location and distances from - > - �• property line and between buildings" 1 f,l l... . . ` .-nl 4 ,r .. • . - 'l OWNER MATTEWS, KENNETH C' DATE 12-22-61 JOB ADDREST7 E. 21st. St. BUILDING PERMIT NO. 16016 GENERAL CONTRACTOR Owner–Bldr. VALUE S 1 000.00 AP Nd.18-143-06 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Det.Pvt.Green 1N PECTIONS Signature DATE GROUP J. TYPE V ZONE El house SUBCONTRACTOR PERMITS ISSUED GasDATE NUMBER Water Rough Com. Refrig. ❑ Air Cond. 0 - - Rough Heating Rough Plumbing Miscellaneous Prop.Swr.Line 0 House Con. ❑ St.Swr. 0 Sprinkling System Construction Pole Underground 0 Power ❑ 0 Rough Wiring - -- /6 S'P7 Trenches 0 Forms 0 Steel Reinf. 0 16 27 c_- /Z. ✓Ji �§ 1— o l I _Pf'Ji Floor System Bond Beam 0 Steel Reinforce ❑ _ Sheathing _ Frame and Flashing f/ -44.<a] Lathing — In ❑ Out ❑ '°' f Plaster, brown coat r g. 0 Air Cond. 0 Final k. .ng, Final Plumbing Fixtures, Final - Final Gas Test A(4.1--C, Electric Fixtures, Final 4 H14-(3-1"- Building, Final OCCUPANCY FORM 8U4•5M - 7-61 15016 FEE RECEIVED • 4 '-` 1601.6 QEC COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE � � ecU' P. O. BOX 317 COSTA MESA. CALIFORNIA . CITY OF COSTA MESA For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT -yam BUILDING . . BUILDING . ADDRESS ..7 .7 7 IV o214a21 }.0--- -1-.41 -.. COSTA MESA. MESA. CALIFORNNIIAFor Office Use Only I RECEIPT NO. PERMIT . OWNER <rMfEfN C Nam E I /S® /6 Rem DA = R • MAIL. ADDRESS 7/ F c.2 JZ.- E t 'aI'i 'L 'y rI / - 22--. &' A BUILDIN•V ADDRESS grrnil _ rr • COSTA MESA. CALIFORNIA ADDRESS •- � .�.' FIRE y �' ZONE / TYPE GROUP CONTRACTOR r ' 'x-!J/L-'gl. i APPROVE•/ ft- BY r DATE/ "z-6// ADDRESS ZONING 20 CITY ZONENO.OF' I PLANS I BUILDING OF NEW , - , \ STATE TEL. • , LEGAL ////���� /n�LP( ,,//1 V/ LIC.NO. NO. DESCRIPTIO ` OA / 'J _ SIZE // p x ) NO. M stops. / (/ , OF LOT(Q y / � NOW ON LOT A.P.NO./! - /4 .5-- O (,,, USE OF YARDS 'EVES EXISTING BLDG. .�-e�--- ea C . -=- APPROVED ALLOWED SETBACK LINE FROM /���O� / (CENTER LINE ST.) / CENTER OF STREET 6 ?�L'^�+-REAR YARD �Y' FRONT (7 FT. __,.J • IN. SIDE YARD I LEFT �4 I RIGHT ss>2 . R.SIDE .3S'FT. IN. DESCRIPTION OF WORK L.SIDE TFT. f IN. NEW 14- II ALTERATION 4I II ADDITION I L. REAR '/Js�FT. -f— IN. I II MOVING I II DEMOLISH I APPROVED /• y' � DATE 12-/1-/ I REPAY?' W ` 10 SIZE BUILDING /,/%si OI' ROOMS / STORIES / EXTERIOR WALL I ROOF COVERING COVERING USE OF BU LDING N WORK TO BE PERFOMER D I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE / AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. / ' PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING B O BUILDING CONSTRUCTION. VALVATTT\\\111ON I SIGNATURE OE., )�� / 1. PERMIT FEE $ 6 PERMITTEE /?���_"""`""'`_27F• ' , m ,7-2l/e -�J $/ �'O` -- w' 7 AUTHORIZED AGENT /.�-0 O 5 TOTAL FEE (IJ u