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GENERAL CONTRACTOR
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Forms
DATE .7 �7 v/ .
BUII.DING PEItMIT NO.
DESCRIPTION OF WORK Tt'ip1PX W Stt. G
SUBCONTRACTOR
23706
COSTA MESA BUILDINGSAFEfY DEPARTMENT
P.O. BOX Jt] C09TA M88A. CALIPOHNIA
For ApplJcant to Fill In Complataly
TYPE OR PRINT
COSTA MESA,
■ MAIL
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DESCRIPTION OF WORK
IA
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I NEPBBY ACKryp�y�gOO! THAT 1 MAVH PHAO TMIB APPLIC/�TION
AN� 6TATE THAT TH8 ABOVH 19 CORRHR AND AOqgg TO COM.
PLY WITX ALL CITY ORDINANCHB AND BTATB LAW9 q80ULATINa
BIIILOINOCONBTpUCTI N. .
PERM^IITE�F^-�,bi/J.`. �//�//d'h ��
AUTHORIZED AGENT
MAR 9 1965
P IICATI� [� �Rl�
arnivc�--
� r For Offica Usa Only
R8C[II� NO. _ P[R
APPROVED
NO. O!
PUNB
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uGf `�U�" G�o
EAV 8 OV ERHANO HHALL BE LH88 TMAN
YARDS MPROVED
MAIN BUILDIN6
o�srarvce eer.
MAIN BLDG3.
VAR. �C
YARDSAPPROVED
AGCESSORY BUIL�IN6
DATE
{2EQUIREMENTS
g d ea Fr. 6' "� "
0
THG AMOYNT BNOWN UNDBH VA�UATION 18 FOR TMH y
PIlPP058 OP 88TABL18H�N0 A PENMIT FE8 ONLY. �
VALl1ATION p,�. m
PERMIT FEE 4 �
7
� m
g ,ct/`� /D� / L c �9 �
/ , TOTAL FEE $ / • �