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Home My WebLink About167 17TH ST - Building Permits 4,44-01 OWNER MAYFAIRMarket DATE 12-14-62 JOB ADDRESS 167 E. 17th st. JJ BUILDING PERMIT NO. 18299 GENERAL CONTRACTOR Heath & C O. VALUE $ 950.00 AP No.117-081-53 LOT TRACT FIRE ZONE DESCRIPTION OF WORKFrstdg.Elec. INSPECTIONS Signature DATE GROUP TYPE ZONE C-2 Sign ISSUED Gas SUBCONTRACTOR DATERMI1SNUMBER Water Rough Com. Refrig. D Air Cond. 0 Rough Heating Rough Plumbing Miscellaneous Prop.Swr.Line ❑ House Con. 0 St.Swr. 0 Sprinkling System Constructione Underground 0 Power ❑ � Rough Wiring l % (1 . //-3o-bd .Q/d 07 Trenches 0 Forms ❑ Steel Hemf. 0 ITh ,2 -ct✓ Floor System Bond Beam ❑ Steel Reinforce 0 Sheathing Frame and Flashing Lathing — In 0 Out ❑ Plaster, brown coat R, r, ,. ❑ Air Cond. 0 Final g, Final Plumbing Fixtures, Final Final Gas Test ,Building, Fixtures, Final fat IA n3 Building, Final OCCUPANCY FORM 8U4.5M — 7.61 154000 OWNER FOX MARKET 7'q& # 4/3 $, DATE 8-2-60 JOB ADDRESS 167 E. 17th St. � -.--n+ /7 n_ ..�++i �.i BUILDING PERMIT NO. 12630 GENERAL CONTRACTOR Heath & Co.0 / VALUE $ 900.0U AP.No117-091-47-24 LOT TRACT _ FIRE ZONE DESCRIPTION OF WORK Post SignuSig 11�� INSPECTIONS DATE GROUP TYPE ZONE +� Iijlt)rground Soil U.G. Water PERMITS ISSUED . l r$ rground Gas — — SUBCONTRACTOR DATE _ NUMBER Overhead Water and Gas Rough Heating Rough Plumbing Miscellaneous Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating, Final Plumbing Fixtures Final Gas Test • Construction Pole Underground Power Rough Wiring A-s - -de i 3/654" Trenches Forms Steel }—g `S -t Y - C o gi km a0. i Floor System Steel Reinforce Chimney Re-Rod Bond Beam Sheathing Frame and Flashing Lr„t'.ing, In Out Vfklkl'ar, brown coat Plumbing Fixtures, Final Electric Fixtures, Final (!f/ s\ 5=11C-Ci Building, Final I /it.h /4-Cf OCCUPANCY �` Form 210-5M-11-59 S-s P 12630 Aid lt 2 6 1660 OWNER FOX MARKET DATE 17 -12-C$ JOB ADDRESS J 67 - 1 7th Street BUILDING PERMIT NO. 10819 GENERAL CONTRACTOR Heath & Company VALUE $i_67_00 AP. No. 117-081-gin LOT TRACT FIRE ZONE DESCRIPTION OF WORK sl¢n R'-°ECTIONS '26, & 27 DATE GROUP TYPE ZONE 02 .[ground Soil U.G. Water PERMITS ISSUED Underground Gas — SUBCONTRACTOR DATE NUMBER Overhead Water and Gas 2SY Rough Heating ' Rough Plumbing Miscellaneous Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating, Final Plumbing Fixtures Final Gas Test Construction Pole Underground Power I/ Rough Wiring .-i. (3.••• I • ////� 10 9/e Trenches Forms Steel Floor System Steel Reinforce Chimney Re-Rod Bond Beam _ Sheathing le and Flashing In Out Plaster, brown coat Plumbing Fixtures, Final Electric Fixtures, Final "YIP S-y op Building, Final OCCUPANCY - - Form 210-3M-4.59 - - 10819 OWNER 1,FNNON� J: WARREN aPRa 8 18DATE 10-19-59 JOB ADDRESS 167 E. 17th Street BUILDING PERMIT NO. 10588 GENERAL CONTRACTOR E. W. Hahn VALUE $ 320.00 • AR No.117-081-27�26 0T 72282 TRAC'INPt Fits FIRE ZONE DESCRIPTION OF WORK retain wall INSPECTIONS 09610 21 DATE GROUP TYPE ZONE rground Soil U.G. Water PERMITS ISSUED _ Underground Gas — SUBCONTRACTOR DATE NUMBER Overhead Water and Gas Rough Heating Rough Plumbing Miscellaneous Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating, Final Plumbing Fixtures Final Gas Test Construction Pole Underground Power Rough Wiring Trenches Forms Steel Floor System Steel Reinforce Chimney Re-Rod Bond Beam Sheathing &,: e and Flashing L',..kng, In Out Plaster, brown coat • Plumbing Fixtures, Final Electric Fixtures, Final . Building, Final OCCUPANCY I Form 210-3M-4-59 10588 OWNER APR 2 6 1960 FOX MARKETS DATE 11 .A-59 — JOB ADDRESS 167 - 17th Street BUILDING PERMIT NO.10790 _ GENERAL CONTRACTOR Heath Re Compry VALUE $ soca) AP. No. 117-081-9';10JBtt27 TRACT FIRE ZONE DESCRIPTION OF WORK sign It' PECTIONS DATE I GROUP TYPE ZONE C2 :rground Soil U.G. Water _ SUBCONTRACTOR PERMITS ISSUED Underground Gas DATE NUMBER Overhead Water and Gas -14.- ---i. '� Rough Heating k ✓ _-15 Rough Plumbing _ - 4 Miscellaneous / Prop. Swr. Linc • House Con. St. Swr. is; Sprinkling System I ' dl 7 J��',/ pHeating, Final r z, _ill D _�// Plumbing Fixtures • f Final Gas Test tib'4^F ✓' Construction Pole /' !!!✓✓✓ Underground Power -r� / Rough Wiring qv - v- 0.-0 - —TRW / 0/5- S / Trenches Forms Steel Floor System Steel Reinforce Chimney Re-Rod _ Bond Beam Sheathing _ > VI-le and Flashing - 11'.5 Ing, In Out Plaster, brown coat Plumbing Fixtures, Final Electric Fixtures, Final 19- j --5 yGFp _Building, Final ��J OCCUPANCY L1J 5;41-1C) Form 210-3M-1-59 1(Wen OWNER FOX MARKETS nrR 2 6 1960 DATE 11_A-59 JOB ADDRESS 167 - 17th Street BUILDING PERMIT NO. 3070 GENERAL CONTRACTOR Heath & Company VALUE $ 300.00 _ AP. No. 117-081-91DOT 926,92TRACT FIRE ZONE DESCRIPTION OF WORK Sign Ir••-°ECTIONS DATE I GROUP TYPE ZONE C2 . aground Soil U.G. Water PERMITS ISSUED Underground Gas SUBCONTRACTOR DATE NUMBER Overhead Water and Gas Rough Heating � � - Rough Plumbing +e/�`l 7 :.34 -� Miscellaneous Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating, Final Plumbing Fixtures Final Gas Test Construction Pole Underground Power Rough Wiring an w )—71./ c, / 0 • 'S 2 /1 Trenches Forms Steel 0.41-142/114-1744.-d.- • Floor System . .21 Steel Reinforce Chimney Re-Rod Bond Beam - Sheathing g:SPP;e and Flashing L5_"ng, In Out Plaster, brown coat Plumbing Fixtures, Final Electric Fixtures, Final az, (-u/le Buildin•, Fina] , _ OCCUPANCY _ ..{-di.‘) Form 210-3M-4.59 ] 1n'/An APR z 6 1960 OWNER VAN DE KAMPS DATE 11-3-59 JOB ADDRESS 167 E. 17th St. BUILDING PERMIT NO. 10699 GENERAL CONTRACTOR Advance Neon Sign Co. VALUE $ 600.00 AP. No. 117-081-10-976e7 TRACT FIRE ZONE DESCRIPTION OF WORK Bldg. Sign I'"SECTIONS DATE I GROUP TYPE ZONE C-2 :rground Soil U.G. Water — SUBCONTRACTOR PERMITS ISSUED Underground Gas DATE NUMBER Overhead Water and Ga$ Rough Pb Rough Plumbing Miscellaneous Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating, Final Plumbing Fixtures • Final Gas Test • Construction Pole Underground Power Rough Wiring ✓H(J nBe !✓2ot� J; /�-r� -JS /O PUS Trenches Forms Steel Floor System Steel Reinforce Chimney Re-Rod Bond Beam Sheathing F e and Flashing L, .ng, In Out Plaster, brown coat Plumbing Fixtures, Final Electric Fixtures, Final C=9-- • Building, Final % E�I/� AOCCUPANCY t Kam 210-3M-4-59 1069! OWNER LENNON. WARREN•J. DATE 4-211-59 JOB ADDRESS 167 E. 17th St. BUILDING PERMIT NO. 8709 GENERAL ONTgqR�A11C��TOR ��7E.W. Hahn VALUE $ 169,000 AP. 7—obi-G'LD7"'�"'ZTRACT FIRE ZONE DESCRIPTION OF WORK Market r'-'CUP F2 • TYPE V ZONE C2 & R11 PLAN NO. 8709 1,.aPECTIONS DATE SUBCONTRACTOR' _ PERMITS ISSUED IA' DATE NUMBER Trenches`$ Forms)( Steels .{--, g '(, o vle;c-C.- 14;c- -c A ':!" ,"fTheer L --ti.-3-7 Floor System .11-Z, S Y (. .- /...rjV- " 4 " 's/ Steel Reinforce% Chimney Re-Rod „S' ' ' <" "' "' �• Bond Beam Q + • ' ,T V 4' tj Frame and Flashing •� a `S- (, -13 - , �f1 Lathing, In Out 9}.-; -,r7 -'' - n l .9 -5- Plaster, brown coaE Underground soil it WIG Pipe Test I Top Out i a- Se t Furnace - /' /fl/�if71��i»/dlr/S-�1 i�l� t�� .i._• . 9'/ 7 . 0 Gas Ven � i :. .__. .L�ii 020 L._ Rough Plumbing / "„i' (.. Cesspool Septic Tank , Prop. Swr. Line 1/House Con r St. Swr �`� alli — r _' Sprinkling System - .`� I tfZfl e S '.r i lb ' - D 1 S Heating Final I �Ii L:L r Sins Fixtures, Final • r" rte. =>� _.1 I MEET a.O I alb Test --- '�f(4iffliidEln `/J- ' . d re.) Construction 'ole a' . if ,q, /" eingaM ilri, 'S> '. Underground Power Rough Wiring ' 7 . Fixtures, Final n MI Y. OCCUPANCY rs. - Form 210-5M—I-5T r-'. HOLD FS SPF AI. R' 1tltnc,irxrw 'erfn- 8709 /VG/C.1 e 71 /7- rt / (! ✓ ate u�fiW o 4-1 . .5.4-G S "4 r2 t 4r•� tiu /tie/'c.✓ kV--✓ ' rte e7 -.y -res 7U r AirL C -e- �' $ - 9- /7-1/413?" fit,2 Sv�y.- Lef.4/4 ` 4 C Gmay " /D//5" AtZL Qa<-�j �� `j -4- c ..,.� Gvs-..�✓lrliili �i _'�: Il ? a ' " yrenINA; _! �t� k X F;-',-.9,4\Ctlur I Flilr ^ITE N �� / P.O.BOX 317 �. -I, t_ DEPT. 4. I I OSTA MESA, CALIFORNIA • ''•TV r'.. !flcril ^IFS! w Mrr rw APPLICANT TO FILL IN APPLICATION FOR PERMIT Ili _ B 4•.•: -,_•.,•'a 7 . c... / 7 T/,` 5t. BUILDING , ADDRESS COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY I RECEIPT NO. ERMIT N . OWNER ‘iA22az/ Exl/Vo.V '- /7(1 �J/J / /� C /7 RECEIVED� �B�Y/ �JDATE RECEIVED yy�E �SUUE ADDRESS 474 ///ttyEotG.. D/2 ' `/�•-%`� �f'�T - --2s-S-7-J / Z7/57 CITY GA�y�jU�c./A ��+ TN O. BUILD? �G., ADDRESS / 6// ZL OR FH ITEVEER 206T .4'. /,(/$rs:gQLjgq. e /T )4, COSTA MESA. CALIFORNIA ADDRESS //j� (� • k 94-Alar 17,s47- FIRE ZONE , —7'-74741-1 Zp NE NO.OF TYPE GROUP Fy' ,I/ CITY CIC. _.n PLANS Z /�Xj/�_ CONTRACTOR(1j >� , NO. (%�.¢R ADDRESS 2/' Z. 'yaMc'-.J O.£ E' 6 APPROVED`L �_yt re710 D.. LEGAL LOT �• N �� n �/�. Q . O RECT�O�� > DESCRIPTION •-�No. O / O�C7K/ p TtRACTn A.P.NO.fi /-OR/'� .. 7�0°(C'�Io 6*-a. / `y \Q,`/}ry py�9 . SIZE > NO.6P BLOCS. A (!-��1/ ��, 11 FI Cl' .J H II OF LOT 4P5-441 ] Do 1 s INOW ON LOTa (jL.'S F• A "iai'.' r }LI' USE OF 2‘917.:-/- )4..4. EAISTING BLDG. /C65/Q � CITY OF l(.':7 •� MESA SETBACK LINE FROM / I FI/ . .+1 .i T VL.( .. CENTER OF STREET /2d.yg REAR YARD SUBJECT TO BIG. DEPT. REG. I SIDE VAR IGHT AWC- Vg LEFT ?.. a9 j //�' ,l//�, DESCRIPTION OF WORK BY IV• •` /j,DAATE g• 'AV yIIII PI AN TI-CH.(///I NEW pALTERATION ADDITION , ,. •-•• v-1 REPAIR MOVING DEMOLISH tlI ( \ ;•' �I 141 •{ SI �s c_A BUILDINGNO OF SIZE /7a X �� ROOMS STORIES / 7^. •"a 7 •1 ; 9.•' + EXTERIOR WALL((�j�� ROOF C/ t , f '• j .; I _COVERING L�./CfG• COVERIN r .• ! I ' USE OF NEW /�/�/� �..•� (/ r BUILDING `,247 Z.e+/ \ D �_ �.4 r - U ,C2c ••••c.0 Or :L,Lf-t---- , c:-._. / r a HO D FOR SPECIAL REQUIREMENTS T • ., IoW under vafuafim is f.v flip • I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND purpose of establishing a p STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL nn _ _ permit fee oay. CITY ORDINANCES A��jjjPPP STATE L REGULATING BUILDING CONSTRUC- '-2 ST/ S ��0 / La2 _ TION. J�0 ' �() ` VALUATION SIGNATURE OF e../02 G /J ,(�/�''1�17 PERMIT FEE S 7 �.5 m PERMITTEE C\,G S./° 7 ., / PLAN CHECK S C/ 54. LJ AUTHORIZED AGENT TOTAL FEE S / 9,,g. 7,c-r.-, 10588 •• FEE RECEIVED COSTA MESA BUILDING-SAFETY DEPARTMENT • P.O.BOX 317 COSTA MESA. CALIFORNIA F�� 'X*'O`at4.2 "'p_f(9_t.0 FOR APPLICANT TO MI /N COMPLETELY APPLICAPtSNRpT FERMITI TYPE OR PRINT I. IY OF r(IRTA MCQA /, BUILDING BUILDING /G 7 try •�•CCC!!!X'/•, /�/ w�,// ADDRESS G / COSTA MESA, CALIFORNIA fOR OFFICE USE ONLY OWNERI: biel4,12 r# 2 tw17o g IRECEIPT NO. I 1645 b6 MAIL �7'/ �/ �+ /•` �7 RECEIVED A.:r- Df/T�E RE/C¢y�VCDr DATE ISSUED ADDRES/Sn/� t//r LLC�'/Nt F/� /�•f /o / `J/I nnn CITY F./]N /)/lA �fjQ�l7 TEL BUILDING )/. `7 - /`..r//-' ADDRESS ` V //^ / / !JV / ARORCHITECTNEER, 8T N' 4/Nsw5C7,14D`: . 4-/.flab' COSTA MESA, CALIFORNIA FIRE ADDNESS j/f7 Ie,ddd u'/A' iWot ,P/4ti. ZONE TYPE //I /I GROU//�P{////�/ ///(_�/I� CONTRACTOR, I ry, 4,-, LIC.NO. APPROVEDSTATE V 7 I DATE//� // ' / ♦ C� �// /� BY I ADDRESS�/p LIv. NAMT//d.#t MVP449,p- ZONING Rpi , LEGAL Lot Afr'/CNy�fw )� ZONE/n• / NO.OF ,_ USE OF NEW `.1 y DESCRIPTION I NO.e` Pa/PADLO/CK /� l I TRACT/(,Et'4�� v �I PLANSS /I BUILDING //1 U ' A.P.NO.I�? Ml/ -oC ( 2B� L^% /QfgI APBY /._ y. D/ DATE /(((I0- _S/ SIZE .a�`` NO.OF BLOCS. // •i LIVES 7 OF LOT .V '-X x/700, is- (NOW ON LOT. REQUIRED ALLOWED USE OF 71)MC goa /-,-- (CENTER LINE ST.) EXISTING BLDG FRONT :5 _J_.0OFT. / IN. SETBACK LINE FROM CENTER OF STREET REAR YARD R.SIDE FT. IN. SIDE YARD I LEFT I RIGHT L.SIDE c.-- FT. IN. DESCRIPTION OF WORK //--BB REAR FT. OIN. NEV I II ALTERATION I II ADDITION I REPAIR I II MOVING I II DEMOLISH I BUILDING NO.OF SIZE ROOMS STORIES EXTERIOR WALL IROOF COVERING COVERING LISF OF BUILDING AND WORK TO BE PERFORMED X.FTA/N/,/G LI LL- 2! o X a�-o I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PLY WITH ALL CITY ORDINANCES AND STAT LAWS REGULATING PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. BUILDING CONSTRUCTI•N. n VALUATION SIGNATURE OF // PERMIT FEE $2 �` PERMITTEE f M4 .��L- sios a PLAN CHECK s AUTHORIZED AGENT z �•�` TOTAL FEE S COSTA MESA BUILDING-SAFETY DEPARTMENT 'Q&2//-2 -37 P.O.BOX 317 COSTA MESA. CALIFORNIA FINANCE DEPT. FOR APPLICANT TO TILL IN COMPLETELYAPPLICATION rFOR' PERMIT TYPE OR PRINT ��/ BUILDING AD /i7 g /9.T, /70n/' matin ADDRESS / L �r COSTA MESA, CALIFORNIA FOR OFF/ O ONLY I, / RE IPT N PERMIT GNO./ OWNER J. 11/4/2:47.6N 2�/1'/11OA1 I �f V MAIL 429 �/L`ErCE BY 1dA PEC v�q^ oAreI88UEoADDRESS nf/, D•QI / V i fi/ I /�-� •�'CITY L c aAM .E/ICN TNO. \c\fiEllED ILDING J 1 '/ /� // ADDRESS ARCHITECT /Pe: /S /T/yt y pri NO. /'-/�2 OF SI NEER ''/ COSTA MESA, CALIFORNIA ADDRESS //77 C S'A4A/� 19;15 9OEA/Q Z NE TYPE GROUP .� 11//�/g / STATE B ED b �,�AA CONTRACTOR LIC.NO. BY DATE/1" ADDRESSe7/9 S. AL.41enda/9415- irld,✓P, iardl Ietr ZONING 7 LEGAL LO ',ern."' /cLET ZONE q . `NO.OF USE OF NEW i/ n DESCRIPTION I NO.Bf /j2/lgj BLOCK TRACT//f ar L/1/_/l/II PLANE BUILDING IP �fBYPROVE•, ! i LIC). DTE A.P.NO^./��/-NA/" , d( a- J7' / • • ` ///�� SIZE O/„5Q.,c 7o01 /S.- I NO.OF BLOCS. YARDS EVE (O 30-S7 OF LOT 94/7 rx. JAM -t NOW ON LOT .x REQUIRED ALLOWED / USE OF / (CENTER LINE ST./ ''�� 1 EXISTING BLDG. FRONT dC^^/FT. IN. SETBACK LINE FROM I CENTER OF STREET REAR YARD R.SIDE FT. f IN. SIDE YARD I LEFT I RIGHT L.SIDE FT. // IN. DESCRIPTION OF' WORK REAR FT. IN. NE I II ALTERATION I II ADDITION I • • REPAIR I II MOVING I II DEMOLISH I BUILDING NO.OF AI SIZE ROOMS STORIES t� 71 EXTERIOR WALL IROOF gx„As J/� 0/ COVERING COVERING USE OF BUILDING AND WORK TO BE PIRFORMED I I/e 5/ / "94eCe- IJALL deraCl- �y, ,1 VY g4 X3?",(3 7 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. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. BUILDING CONSTRUCTIO . VALUATION PERMITTEE .� '.b SIGNATURE OFJ .02o _ /� 194-- O,( PERMIT FEE $ /q $ a, 6 ape) PLAN CHECK $ /// AUTHORIZED AGENT TOTAL FEE $ /S ti0 COSTA/MESA BULDINNG-SAFETY DEPARTMENT �""Erg D P. O. BOX 917 COSTA MESA. CALIFORNIA d ter}-' T. Ford Applicant to Fill In Completely RIMA APPLICATION F DEFY, PP P Y (F1O� RIPERIvilT TYPE OR PRINT CIO ur l'UJ111 BUILDIN* / BUILDING ADDRESS /�7F/ f/ �� COSTA MESA. CALIFORNIA For Office Use Only RECEIPT NO. PE M)7 HO. OWNER A`-OX 4- 4 7--- MAIL. .-7B' i�OS ! ' .3C MAIL /, RECEIVED B I Dj/ RE yE */ ,s ri ADDRESS a - 1 L 6� G TEL. BUILD! '• CIT ' . NO. ADDRESS ARC,_-•ECT �/ TEL COSTA ESA. LIFORNIA t OR ENGINEER�/ AP//-''4 a /� jn/ gear ADDRESSg/2N. '/�El 40 devA yJ 2 /4 . FIRE �� / to - %1/ }-/� y-(� /�1 ZONE TYPE / GROUP87-.-11 V C-^-r r C a ByAP / ATE O ✓ 6 D CONTRACTOR / f LIQ . ZONING / • ADDRESb1/2- /V .1443/A�Jy �i�• I ZONE POOR USEIOF NEW CITY )/ �/,1 /P�/LSA/N)B // BU�I/LDING-f Lb'-IrC.TNOf 872 %.11/47F �/Z7 DESCRIPTION I/' �r l�a!1'/' Try' SIZE 2�'7 X✓✓h I NO. OP BLDGB. l --el OF LOTp�0I. 7.5—/`.�7o't' I NOW ON LOT A.P.NO. I 1 0 /- /% OI EX STING BLDG. a 7- APPROVEUSE OF YARDS D�J I Ee OWED�• cS SETBACK UNE FROM (CENTER LINE ST.) CENTER OF STREET REAR YARD FRONT i ,a/ FT. SIN. SIDE YARD I LEFT I RIGHT R.SIDE FT. - U 4. IN. DESCRIPTION OF WORK _ L.SIDE , 7L-CT 9FT. IN. NEW I PHI ALTERATION I II ADDITION I REARL-S---FT. • IN. REPAIR - I II MOVING I II DEMOLISH I APPROVEDyj/. / a EY \Y {. l�f DATE /p BUILDING NO. OF V f I I \ J SIZE ROOMS STORIES PK I{. L ,�"± 1I1 I EXTERIOR WALL I ROOF ' COVERING rJ) �f 1 n, 17 T, d I r , COVERING USE OF BUILDING AND WORK TO BE PERFORMED a ke u L .COS _ 11 yid- p PC/I3b ei7•Qr'FD app A ' � _ 2 4--,C.-} / s iy L,coe, oh 04,9 /4t APAAD nin 7-2 r-, DATE /-6,� nDn � vcn I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICA N TRE AMOUNT-UROWN-ONDER-VALVA,IUrIS'- •- • AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PLY WITH ALL CITY ORDI "• ANMD/ST LAW= -I.GULATINO PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. BUILDING CON' d�N. %' /n / a_- VALUATION ,.e.;) L� L-f" PERMIT FEE $ (Y' -- SIGNATURE OF - / PERM ITTE' t/ � " -, �T N 8' )- v/( - ' - $ PO PLAN CHECK S AUTHORIZED AGENT ' 11 TOTAL FEE $ Y' ----- N