HomeMy WebLinkAbout107 INDUSTRIAL WAY - Building Permits . 13504 FEE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT Qin
1� py DEC 15 ma
P. O. BOX 317 COSTA MESA. CALIFORNIA gg��FINANCE ARO
For Applicant to Fill In Completely APPLICATIO9V cJ ARO MESA
77 Q,TY,PE'OORR PRINT� IBUILDING
ADDRESS/v(kkviiA, T at.t
COSTA MESA. CALIFORNIA" For Office Use Only
RECEIPT NO. '-'Y�, N�0.L
OWNER I 11' `
LI._'
MAIL - /% RHC/g�y�O 0Y DATE : CEIV 0 / DATE ISOU--
ADDRESS d _//.4 !,./atm-'._ ' / �/ V .]/ ' t
11/ TE'?� . 5 It •' BUILDING
CITY eta/a( - ! A i NO. ' ADDRESS
ARCHITECT Qo TEL. 11 COSTA MESA. CALIFORNIA
OR ENGINEER �(I�.� NO.
ADDRESS ♦T FIRE
ZONE TYPE Ve GROUP UJB
CONTRACTOR II APPROVED
AP DATE
ADDRESS R ZONING „(2,./
ZONE NO.OF USE OF NEW a�/ .
CITY 1 -,---7,7/ /I PLANS BUILDING — I f
STATE TEL. DEGARIP (Pei
/6 J
LIC.NO. • NO. DESCRIPTION
((///
OF LOT /4-G X / L I NOW ON LOTS
USE OP V YARDS EVES
EXISTING BLDG. APPROVED ALLOWED
•
6RBACK LIMB FROM "/ (CENTER LINE 6T.) aCENTER OP STREET �� �� REAR YARD ^ FRONT - '('
fit
c/ ' IcAZ4
SIDE YARD LEFT I RIGHT R.SIDE ..- ----- T •• r IN.
DESCRIPTION OF WORK�/
L.SIDE laFT.5/ N`1
NEW I /I.IIALTERATION I II ADDITION I REAR / ✓pT. ''//IN..,�
MOVING I DEMOLISH I BYPROVED/�/� O DATE ).Q-f 4'
REPAIRI / ( 1 n •�
B Z SING 5k la ROOMS / STORIES V J
EXTERIOR WALL J2 OOF
COVERING / iG"`�"COVERING
USE OF BUILDING 0 WORK TO BE PERFORM D
•
t.72/079...-• lif-alka- n7,-/44.-
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 OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONS U O VALUATION
SIGNATURE OF //y'y� /4: PERMIT FEE $ g�
PERMITTEE / 1 , ^"�'�' �_ e_
♦ $ ��P"`��� PLAN CHECK S `II,
I .
AUTHORIZED AGENT E
TOTAL FEE - -- 0