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ZOSTA MESA BUILDING -SAFETY DEPARTMENT
P. O. BOX 317 COSTA MESA. CALIFORNIA
For Applicant to Fill In. Completely
TYPE OR PRINT
BUILDING' / �/Y ^ e-
ADDRE88 CI
COSTA MESA. CALIFORNIA
jy' JUN 7 1962`"
FINANCE DEPT.
n TV nn( TA
APPLICATION�'FOR PERMIT( MESA
BUILDING
For Office Use Only
RECEIPT NO.
OWNER
�
11
MAIL
RECEIVBY D RE O �/ GATE BB E
ADDRESS
"--
TEL.
BUILDING -
CITY 1
NO.
ADDRESS
ARr -ECT
TEL
COSTA MESA. CALIFORNIA
OR [NEER
FIRE
ADDRESS ^�--�""�—
ZONE TYPE GROUP
APPROVED
CONTRACTOR
BY DATE
ADDRESS
4z,GL
NING
ZON!
NO. OF
UBE OF NEW W/}
CITU -
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C�
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I BUILDING TC
STATE
q -T TEL.
_ Z
LEGAL Qf l- y -
LIC. NO.
b L NO.
DESCRIPTION
SIZE
'1 NO. OF BLDGS.
D
/ !-� z —617
/
OF LOT
NOW'ON LOT
A. P. NO. /4 •
USE OF
_YARDS
L
EVES
EXISTING BLDG.
APPROVED ALLOWED
SETBACK LINE FROM
�^-
-J %-
ICENTER LINE .TJ
��
CENTER OF STREET
REAR YARD
FRONT FT. IN.
I
/
I
SIDE AND LEFT
RIGHT
R. SIDE V.i- FT. IN.
DESCRIPTION OF WORK
/ --
L. SIDE FT. IN.
(ALTERATION
I I I
'f
NEV
ADDITION
REAR / FT.
REPAIR I (MOVING
I (DEMOLISH I
/ /IN.
APPROVED L,_ DATE
BUILDING
SIZE
ROOMS STORIES
-
-RIOR ALL
-
9
COVERING
COVERING
USE OF BUILDING AND WORK TO BE PERFORMED.
1 HEREBY ACKNOWLEDGE THAT 1 NAVE READ THIS APPLICATION
THB AMOUNT SHOWN UNDER VALUATION 18 FOR THE
AND STATE THAT THB
VE IS CORRECT AND AORES )T{O�
PURPOSE OP, ESTABLISHING A PERMIT FEE
PLY WITH ALL CITY
�COM-
CES NO STATE LAWS YMTI O
ONLY.
VALUATION
/.
BUILDING CONSTRU ON.
SIGNATURE OF
PERMIT FEE $ ✓_(�—
PLAN CHECK $ —_
PERMITTE
'
AUTHORIZED AG5NT
TOTAL FEE