HomeMy WebLinkAbout114 21ST ST - Building Permits=
COSTA MESA BUILDING -SAFETY DEPARTMENT
P. O. BOX 917 COSTA MESA. CALIFORNIA
For Applicant to Fill In Completely
TYPE OR PRINT
BUILDING
ADDRESS O
COSTA MESA. CALIFORNIA
EEE RECEIVED
NOV 301960
FINANCE DEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
4
k- 1-
RECEIPT NO. PH `MI` NO.
OWNER y ` S
Q V e
Y
MAIL
RECEI Y DATE/REC DAT
"
ADDRESS 9 T
'n
�PP
REE
TEL
L�
BUILDING
CITY S 4 NO. SS J
ADDRESS
ARCHITECT
-
TEL.
COSTA MESA. CALIFORNIA
OR ENGINEER
NO.
FIRE
ADDRESS
ZONE
TYPE GROUP
CONTRACTOR eZeQ
C e L
APPROVED
BY
DATE
ADDRESS O8
Yt
ZONING
20
NO. OF
UEE OF HE
CITY [.. 'j Q Q
-'/
PLANE
BUILDING
Ivo
STATEZ TEL.
�/
LEGAL
OO
LIC. NO. 1 b J NO.
5_ 7 /
DESCRIPTION
SIZENO.
OP BLDOE.
I
'I'
OF LOT d 13 S
NOW ON LOT
.R NO.
A.
USE OF
L
//��
YARDS
EVES
EXIST,NG BLDG. 6L l
.� v a Y a
APPROVED
ALLOW
SETBACK LINE FROM i
(
IOENTER LINE ST.)
CENTER OF STREET
REAR YARD
FRONT
IN.
BIDE YARD I LEFT /'S 1
1
I RIGHT
R. SIDE
IN.
DESCRIPTION OF WORK
L. SIDE
IN.
NEW I II ALTERATION I
ADDITION I
REAR
T. IN.
REPAIR I II MOVING
II DEMOLISH I
APPROVED
BY
DATE
BUILDING NO. OF
SIZE ROOM6
3 STORIES
EXTERIOR WALL ROOF
rr�"
LC j Pe
COVERING ( COVERING
USE O BUILDING ALND WORK TO BE
PERFORMED
1 HEREBY ACKNOWLEDGE THAT I HAVE
READ THIS APPLICATION
THE AMOUNT SHOWN UNDER VALUATION IB FOR THE
TATE THAT THE ABOVE IS CORRECT AND AGREE TO COM-
PURPOSE
OF ESTABLISHING A PERMIT FEE ONLY.
ITH ALL CITY ORDINANCEe AND
STATE LAWSREGULATING
VALUATION
PERMIT FEE $i/
ING CONETRUCTIO .
TURE OF
PERMITTER
LAUTHORIZED
/
/
$
PLAN CHECK S
AGENT
TOTAL FEE
4