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Home My WebLink About338 19TH ST - Building Permitsf .�� Applicant t0 till in all spaces exeepl those wlthin heavy Do�tler Iines antl slgn all apP�opriate tleclarations, _,�-• ��'�,Q� COSTA MESA � � a CONSTRUCTION PERMIT Project Address Applicant's Mailing Addreu ��_� Owner's Name Phone�"—� Address �� Arch/Eng. License No. Address y�� r�n � �p Contractor'sNam ��%��h��Cr'W �'�GiPhoneSd]-[.5:2�� Addresslmailing) �Zj � ��"''��=='�'4� f� 1 City Lic?nse No. �� LICENSED CONTRACTOR DECLARATION \ I he�eby.affirm tnat I am licensetl untler prov'slo s of Charter 9(commencing with section �000) of Division 3 of u ne ana rofesslons Cotle, antl � my Iicense is in full force n ftect. i�.( I License Cy1ass � \ Oate- `' � Si9nature — • WORKERS' COMPENSATION DECLA T O � ' lereby afiirm that 1 have a certi(lcate ot consent to selLi re or a certlficate `��,'�_' Workers' Compensatlon Insurance, or a rertlfietl c y ere �( ction, r.-'y�'00, Lab. C T. I PoliGy No. �aZ��Z+Com ny II yI��yI�CertifieG copY is hereby turnishetl. IIpteertifjetlr�qpY�lfd with the city B' DI b 1/. 'p —ZS < APPlicant EXEMATION FROM WORKERS' COMGENSATION DECLARATION� (This section neetl not be completetl i1 the permit is for one huntlretl ( I or less): I certify that in Ihe performance oT the work tor whlch tnis perm�t is suotl I shall not employ any pe�son in dny manne� so as to become Subjec o t�e Workers' Compensatlon Laws ot Callfornia. • DaCe Signature NOTICE: If,'atte� makin9 [his tlecla�atlOn, you Shoultl become subjecl to the Workers' Compensalion provisions ot the Labor Coae, you musl forthwith - comply with such provisions or tnis permit shall be•tleemetl revoketl. CONSTRUCTION LENDING AGENCV � � I hereby a(flrm that tnere is a constructlon lentling agency �or Ihe performance of the work tor whiCh [his Oermit is issuetl (SecHon 3097 Civ. �CJ Lentler's Name tsntler'S AOtlress OWNER BUILDER DECLARATION � I hereby affirm that I am ezempt (rom the C6ntractor's Llcense Law (or lhe followin9 reason (Section ]031.5 Buslness antl Professional Code: Any clty or. countv whlCh reouires a Dermit to construct. alter. improve. tl¢Tolish or repalr -,R`�etrom antl the basis forthe allegetl exemption. Any viola[lon oi SecHon ''+�`,�,�1.5 by any appli<an[ for a permit, sub�ec[s tne appllcant to a civll �� "ldlty of not more Ihan five huntlretl tlollars (§500). � I, as owner ot ihe� oroperty or my employees with wages as their sole <omoensation, will tlo the work, antl the structure is not inteneetl or offeretl tor sale (Section ]064, Business antl Protessional Cotlar The Contractor's License Law tloes not apo�Y to an,owner of a prooerty who builtls or improves thereon, antl who Ooes such work nimsel(/herself or through nis or her own employees, provitletl tha[ such improvements are no[ in[entlatl or otfereG for sale. It, however, the builtling or improvement is soltl within ona year of com- pletion, the owner wlll have the burtlen of proving he/she tlid not builtl or Im- �/ove for the purposa oi sale). U I, as owner of the property, am ezclusively tontracting with Ilcensetl con- tractor5 to ConStrutt tha OrOject (SCctiOn ]044, BUSIne55 antl Plotessioll5 COtle: Tne Contractor's Licenze Law d0¢s not apply to an own¢r 01 prOPerty who builtls or improvez thereon, antl who contra<ts for such projects with a<on- tractor(s) Iicense pursuant to the Contractor's License 1„aw), ❑ ��am exemot untler Sec[ion B. & P. C. for this reason Dafe Owner 1 herebvi certifv tha/�I have reatl thi5 aD icatl0n antl state [nat [he abOve Si9nature � Driver5' LlcenSe or 55 CMF 0865-46 rev. 7/83 to ente/� upon y TYPE OF CONSTRUCTION LI NEW �LJ ADD .0 ALTERATION Ll REPAI R ❑ CONVERSION ❑ DEM IQ� SI� � OTH�R � OESCRIPT�p N OF WORK �� I:,i`�%%� 'A h. L F�A ..• ., - TVPE Of(�ERMIT LJ GRADING LJ FOUNDATION LJ STRVCTURAL ' ❑ TENANT ❑ ELECT�AL .PLVMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTIO 5aN . FT. oCCVPANC`( u �r,r� CON STRUCTION TYPE VALUATION $ _�J_y= ZONE GRADINGCU.VDS. - ACRES Remarks: j� � fF � � / Bar Sink Backflow Preventer Backflow Irrigetion Bathtubs Clarifiers Dishwasher - Drinking Founlains Floor Drains � Floor Sinks ' Gas Service OuUets - Interceptors Kitchen Sink Lavarories P—Trep Roof Drains Reinspaction'Fae $25 Boiler Duct- UnderGround Duc[ - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact BIL ICBO # Heating System & Ducting ❑o-ioo,000 aTu oioo,000 Reinspection Fee $25• White - Builtling; Canary - Ap liwn ; Pink - Accounting; Goltlenrotl - Aszossor . Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Issue Fee Hood or Typel ❑ Canopy Typell ❑ Refrigeration System ❑aioo,000eru ❑too,aoosTu System Repair/Alteretion laua Fee , A.P. # S Main Building: E T Front ARear C Right g Left Ping. Ref. # Parking Req./Provided Use of Building: Planning Notes: Automatic Washer Construction Pole Su6. Cooking Unit Dishwasher • Dryere ❑Gas ❑Elec Fan F.A.U. Fixwres , Device Boxes OuUets Switches Garbage Disposal Generator �0.5 KW C ��r6i 12/15/E° � Zoae Accessory Building: Park.Fees ELECTRICAL �. „, Transformer ❑ 15-50�f ❑ 50tKi Meter LJup to 100 emps C '� Meter❑over100amps � Sub Panel • Motors �0.1 HP � 1`F. - 8- Inc.Solar �9-15 HP �16-15+ �� Microwave � Pole Light � Range Standing Sections , 5 KW Trash Compactor �Qo�_ T�. Z O N I N G R ' E I R E N E N T $ 3 • Reinspection Fee $25 �ssue Fee $ 3 FEES PUBLICSERVICESREaUIREMENTS: � 2oning Approved By Date Application Approved By Date Application luued By % � Date/ �-T SU A Y]pF FEES � BUILDING PERMIT $ � L� SMIP $ + S PLAN CHECK $ �� ,�e �� PEPMIT PLUMBING $ /�'�'� " ISSUANCE $ , PLAN CHECK $ ENERGV P.C. $ ELECTRICAL $ GRADING $ PLANCHECK $ MICROFILM $ � MECHANICAL $ TOTAL FEE $ ll� $ 3 PLAN CHECK $ � { � . CONSTRUCTIONAND'PLAN NG �: P001 'PA � t � � ��' APPROVALS Permit # " � Date Inspector� qppROVALS Permit # - Date Inspector .� � 1. Temporary Electrical Service or Pole _ 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. �.. -'�' • 53. Steel Reinforcement 3. Electcical Conduit Utility�Undrgrnd. � 54. Forms � � -. , 4. Electrical Conduit-Undrgrnd. � 55. Electrical Bonding ' „-' 5. $teel Reinforcement' �� - . 56. Rough Plumbing & Pressure Test 6., Electrical UFER Grnd. • � 57. APPROVAL TO COVER-GUNITE � � 7. Footings � ' ' 58. Electrical Conduit•Undrgrnd.' 8. Foundation ' .� � 59. Gas Pipe, O Undrgmd., Test _ -, 9. Water Pipe-Undrgrnd. � - ' 60. Backwash Lines, P•Trap, O Undrgrnd. ,' - 10. Structural Floor System - - � 61. APPROVAL TO DECK � ._ 11. Property Sewer Line & House Connection '' 62. Backwash & Receptor-Final 12. Sewer Cap � , � 63. Heater & Vent-Final . 13. Roof Drains .� , 64. Plumbing System - Final ' -14. Rough Plumbing'� 65. Electrical-Final � ' 15. Rough Electrical-Conduit � � 66: Shcar System�Final � 16. Rough Electric Wiring � 67. Fencing & Access Approval 77. Rough Wiring Sign 68. APPROVED FOR PLASTERING �18. 'Rough Electrical-T Bar Ceiling ' 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning ' FIRE DEPT. REQUIREMENT � 20. Roogh Factory Fireplace � � APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating � 71. Product Piping OGas ❑Oil ��d23. Gas Pipe-Rough & Test .�� 72, Underground Flush 24. Roof Framing � , 73. Undergrnd.StorageTank OGas ❑Oil . �25. Roof-Sheathing 74. Overhead Hydro � 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standplpe 28. Lathing & Siding . � ' 77. FIXED SYSTEM FINAL 29. Insulation � 78. FIflE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION " 32. Electrical Power Meter-Final � � � 80. FOOD CERTIFICATE ISSUED 33. Final Electric � Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test ; 36. Hood or Canopy � . 37. Final Factory Fireplace - ' . , � 38. Final Plumbing , � � 39. Water Service-Final 40. Gas Service-Final � . 41. Solar pomestic-Final� • y� ( C� . � 42. Backflow Preventer t� � � 43.'Backflow Irrigation � ' 44. ,Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations � 47. FINAL STRUCTURE & BUILDING q e Lo 48. Special Requirements Completed i . 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co . � 51. CERTIFICATE OF OCCUPANCY . No. Date - . ' -.�- AOCII CITY OF COSTA MESA CONSTRUCTION PERMIT _1 Address � � Arch/Eng. � Address \ _ _ . fill in ali sDaeas within neavy EorGer lines ana sign all aporovriata aetlantion tMiT NO. _ TRACT NO. LOT NO: BLDG. NO. licen5e No. TVPE OF CONSTRUCTION �' ❑ NEW ❑ ADD' ❑ ALTERATION' ❑ REPAIR_O CONVERSION� ❑DEMOLISH ❑ OTHER DESCRIPTION�OF WORK - 0922 I/19/B2 ' 8.25 Tl =�''� t ' . � . " - A.P. iF _ ' _ ' -� ZONE' � - PLNG. REF. �i Address VP ❑GRADING'•,,� FOUNDATION ❑STRVCTURAL � LICENSE CONTRA TOR D CLA ATION � ❑ TENANT � ELECTRICAL+�PWMBING ❑MECHANIC I hereby af(Irm th:.f 1 am Ilcensetl untler provisions of Charter 9(tom- � . mantin9 -wlth zecllon 7000) of Divitlon 3 of the BuSiness anO ❑-OTHER. Professlonz Cotla, antl my Ilcense is In full lorta antl eHeY l. ; pROJECT DESCRIPTION �Llcenso CIa55 �� License No.�!�3A � '-- " -- " Date � Si9naturo SQ.�FT.� _ , _ _ O�WORKERS' COMPENSATION DECLARATION . . .� _ OCCVPANCV_CONSTRUCTION TYPE ` 1 hereby affirm Ihat I have a<erti(iwte of consent lo ult-inzure or a VAWATION ZONE `� certifiw[e-of: Worker5'� Compen5dtion .Insurance, Or d Certifiatl copy . ._ .. __ ,p thereol (Sectlqn�8,/p�0� �Z J.. ; GRADING CU. VDS. �� ACRES VI '.y No �F T;' LGamPanY . � . . . � . .�.. . � ertlfietl-copy.iz.hereby furnishe8. _ � . _ . _ _ REMARKSE ' _. _. � � , _ _ _. _ F( �. CertifieG coDY �z filetl witb the city Builaing Division. _ _ _ - r - �� EXEMPTION FROM' WORKERS• COMPENSATION DECLARATION (This sectlon neetl not be completeC if the permit is for one hunUreE � ' J (5300) or leu). • -' ' ` ' ' -"' - ' \ I certity_that in Ine pertormanCe o/ the work for whith thi5 p¢rmit'IS . � issuetl; I shall nol employ any person in any maFner so as [o-0ecome , FLUMBING. J'- ..PIAN'GHECK -'- '- ' - subjecl to the,Workers' Compensation Laws o( Calltornia. Dale Si9nature BATHTUBS - SHOWERS,' — NOTICE: H atter making this tle<15ration, you zhoultl become sub�act TOILETS. �, .-��. -URINALS ' "'� - to the WorkGrS' COTpensation provi5ions of Ibe Labor Cotl¢, you must' � � forthwith comply with zuth provi5ton5 or this permit shall ba tleemetl LAVATORIES DOUBI'E CAVS - . � �lvOkttl. . CONSTRUCTION LENDING AGENCV ' 'KIT. SINK$ -' " ' " DISHWASHERS - I her¢by ditlrm tnat lhere ii d COnStructiOn lentlin9 agency tor Ine per- $ERVIGE $INK$ � . ,i5UMP5' ' ' -� - ' fOrmante ot lhe work fOr which this permit is Issu¢tl (Settion 3097 Civ. C.). ' - � � - - - - - - -- - -- - -- FLOOR SINKS" 'FLOOR DRAINS ' ' LenCer's Nama .Lentler's AUtlress ' '-DRINKING'FOUNTAINS " '• - - - -- OWNER BUILDER DECLARATION INTERCEPTORS -' �CLARIFIERS-- ' I hereby affirm tnat I am exempt from the Contracror's Licenso Law for [he-following-rCaSon-(SecUon 7031.5 Business-dntl-PrOf¢SSiOns COtlO: �SWIMMING POOL ' ' - 'P TRAP - - -� Any City or coun[y which reQui�es a pe�mlt [o conSVuc[, alter, improve; tlemollsM1 or repair any�sbutture, priorto�i[5 issuance, also m- �yyqTER SERVICE ' ACTERATION '- �' ' - qWreS Ih0 ap� Ilrant tor such permit to tlle a Signetl statement that he " IS Iit¢nsetl-pur5udnt to Ihe�provlsion5 ot lhE Conlractor'S-LicanSe-Law -GASSERVICE +� OVT�ET$ "°' 1Chaptar 9(commencing wlth Section 7000) ot Divlsion 3 of [ha ' Buslness antl Professions Cotlo) or thaFho-is-exempt [here(rom antl tho WqTER HEATERS ' BTU'OUTPUT • •'^s tor tho alle9otl exemption. Any violaUon ot Sectlon 7031.5 by applltant tor a permit subjttts the-applicant to a tivil panalty SEWER CONNECTIONS^ • - - -- Jt more than tiW hunaraa tlollars (SS00). � L� 1, es ownar ol- tho prbperly, or my employees witn wagei as'tM1eir SOLAR'TANK' " -' COLLECTORS- � - SOIe CompenSdHOn, will tlo lha work, antl th¢ structwe i5 noI inlantletl br offeratl tor ule.��5eclion 7044, Business antl'Rofessions Cotlai Tha SOLl1R PIPING SVS. " '"- -" ConlraCior's .License Law tloes not appty to an owner ot a property who builUS or imProves thereon, and who tloes 5uch.work himsalf or ISSUE FEE -"' " ''' through nis own employeeS,,Drovitletl that zuch improvements are not Intentletl or offerea Ior zalc. It, howeveq the�bLiltlin9 or improvement MECHANICAL PIAN CHECK Is 5o1G wilnin ono year at compleUon, Ihe owner will hava the burtlen . OI� proving h0 tlitl not 'builtl or imprdve fOr [he Ourpose-Of ule). MEATING $VSTEM Od00,000 BTU ' ❑ A, as-ownar� of-tha-D�Operty, am excluSivety ContrdG[ing wilh �qryD DVCTING - - -- � -- Iitensetl contractors lo construct the pro�ect (Section 1044, Business 100,000+BTV ' antl-ProiMsions Cotle: Tbe Contracto�'s �Licenso ldw tl08s nOt apply to ' ' _ an owner ol property who builtls or improves thereon, antl who con- REFRIGERATION 0-]00,000 BTU �� rdGts Irom Suc�-prOjoCts�with a COnlraCtor(S)-IlceSnatl purivanl_to �SYSTEM�� •--- - _- the Contractor's License Law). 100,000,+ BTV ❑ I am"exempt untler'Section - '' Bl S P. C� lor [nii BOILERS BTV ' reason-- - . . . . . _ - _ . Data Owner SYSTEM REPAIR, ALTERATION I hereby certirytnat I �ave reatl [hiz appliw[ion antl stata that the above EXHAVST SVSTEM MULTIPLE inforina[ion IS "correct. I"agr¢e t0 COmply wit� ail"city antl'county orainances and state laws r �/ig to construct'on, an� hereby authoriza r¢pre5¢nta�ive5 of�his' ItY/t ¢nt¢r u tne 'above'-mentlOnetl property f r i� tl vfp ef Z Signature " Date - ��_ i Drivers' License or 55 $ - � `� - - � " ISSUE FEE -- - - - -- � _. _ �_ __ CMFO865-36 WM1ite-BWItlin9;Unary-Applicant;Pink-Accountfng;Goltlenrotl-Assessor � � � � REAR VARD (TO P/L) ' PKG.SPACEftEQ.� - '-'PROV.IDED.. ' " STREET WIDTH - - - � ' PARK.FEE E - - �nmwr noovnvcn�c..- - � � nn-rr SPECIALCONDITIONS: ' - -' I f ' ' _ _ _ ' _ . . i . ' ' . ' � ELECTRICAL �- - - - - - -�v�Aw CHECK - � - � i _50. FT. ." ' _ ' " _ _ ' ' � -GENERATOR� - - 0=3 KW_1d0 KW " .TRANSFORMER - ' APPLIANCE' 10-SOKW_SO+.KW_,-..� MOTORS- - -0-1 HP-_1-30 HP - .(INC.SOLARI--30-SOHP_SO+HP-� . �, 'FIXTURES --- OVTLETS- SWITCHES � - - - � GAS TUBE SIGNS - - - - - - - �' 'POLELIGMTS'� - '- - - �- -� - "CO7VSTfiOCI"f0 - �POLES ` 'METERED' SUB. ' �PANELS � ' MAIN- - SUB - - � •SERVICE - � �- ' OQ qINP�- - �' -�--�°��_._ .n�i.G '. . . . .. I I I " - - � - - -� �- ISSVEFEE �� -� - � -- ^ - �--1 IAPPLICATION APPROVE� BV . . -. . pATE � � •� � SUMMARV OF,FEES , - . � � � - �BUILDING�-- ' _. .. _ �PERMIT S � •� SMIP ' ' b; PLAN CHECK 5 ' �PERMIT, � • ',PLVMBING . E ",-.�SSUANCE S ' _ � GRADING' E �� PLAN CHECK 5 � . � ,ELECTRICAL E��- . _a•• � � �PLANCHECK E - . �MICROFILM 5 �' ' "'TOTALFEEE� � - 'MECHAfVICHL'E ' - - - " ' LESSAD� ( �� PLANCHECK-5 - �� - VANCEPC-E_ � � •• , • � , _ _ FINALFEE S� i" . _ " " '_. _' =�w= -- CONSTRUCTtON•AND PLANN�ING ��/'� � POOL & SPA�� ' . � , ; APPROVALS Permit#II..gZ Date ' Inspector qppROVALS . �. Permit# ' Date Inspector , 1. Temporary Electrica� Service or Pole � 43. Pool & Equipment Location ' � ' � �' - - -- - - � - - ' Soil ipe-Undrgrn - � 44. Steel Reinforcement - • - - - - 3. _ Electrical.Conduit Utility-Undrgrn . 45. 'Forms - � - . . .. . - - " '• .. 4. Electrical.Conduit-Undrgm � 46.. . Electrical Bonding - - - tee ein orce 47. RougH Plumbin & P�essure Test ---' �� 6. . Electrical UFER Grn � 48, APP.ROVAL TO COVER-GUNITE �- -- • - • - � - - - 7.. . Footings 49. Electrical Conduit-Undr rn � 8. Foundation- _. . � 50. Gas Pipe„� Undr rn;Test � -9.• Water.Pipe-UnBrgrn - 51. Backwash Lines P-Tra- � ridr rn '�• ' . 10.. Struaural.Floor System - 52. APPROVALTO DECK -`- - "' ; it.. Property Sewec Line.&_House Connection 53. Backwash & Rece tor-Final � � � ' � 12. Street.Sewcr Connection. . ' ' -- � � 54. Heater & Vent-Final � 13. Rough..Plumbing. ._ - - - , -- - -- - -- - ._.. . ' . 14. Rough E�ectric-Conduit ` 56. -Electrical-Final -- � ' • 15. Rough Electric-Wiring '- - 57. Solar SYstem•Final ' � - � ' - ' ' ' i 6.• Rough Heating & Air�Conditioning " - � - - - - - • encing &�.Access Approval " � 1-7. Ducts inStructur'e- �,. - - ' ' .APPROVED'FORPLASTERING - � 18. Ducts, Ventilating - � -- - � - - - ' . � � � _ _ _ _ . _ _ . _ _ �� . 19. Gas Pipe-Rough & 7est � - � 60... POOL/SPA SYSTEMS F INAC � ' - , � � . - 20. Roof Framing � -� � � - � � � � � - � 21 . Roof Sheatfiin ' ' - • � �� - � � � • � ' 4 22. Frameand Flashin --- - - -1 -. - . _ NOTES: ' , � ' ' � 23. Insulatiom- - � - -� - 24. Lathing & Sidin9- -�'- - - - - ' � ' ' - --- -' - - - . -. . . , 25. -Drywall Nailing- - ---- . �..-, - ' - ' - � � � � 26. Plaster Brown Coat � � - - ` ' • � ` - - 27: -- Electrical Power MeterFinal - - �y,�- � ' � � � ' � � - 28. -Final Electric �- • - Z � � 29: Final Heating & Air Condiiioning-= - - � - � - - � • � • � � � • ' 30. - Final Gas Pipe-Test � � - � �� ' 31. Final Plumbing ' ' - � ' � ' - � � - 32. Water Service-Final - - - � - - ' ' ' ' � � - - ' � 33. Gas Service-Final - � �� - � � ' 34. Solar pomesticFinal ' � " � " � � ' " ' �- ' � � � - � � � 35. L.andsca e S rinklin S stem � � ' - - � � � � ' � ' � 36. Sound Attenuation ' - ' � � '� " � � ' , 37. Handicap Regulations " ' � - - - � � • - ' " 38. FINALSTRUCTURE&BUILDING - - ' � ' • 39. Special Requirements Completed � � ' ' 40. Electric Release tq Edison � � 41. Gas Release to Southern Califomia Gas Co. ' ' � ' 42. CERTIFICATE OF OCCUPANCY ' No__. Date - - . - - > • --- - - �: - , 19039 COSTA MESA BUILDING-SAFE'fY DEPARTMENT P.O. BOX 91] COBTA M68A. CALIFORNIA For Applicanf fo Fill In Completely TYPE OR PRINT 'o` e`ss 338-E.19th. Street COSTA MESA, CALIFORNIA INER Stenley J.geach REsg 338—E.19th.Street !.�' roR Owner Builder Same TEL �� ..�� NO. OP 8LD08. 9ETBACN L�NC FROM `r � ,� CENTEP OR BTHEEI RHAR YARI SIDBYARDI LEF7 7�0�� RIQHT 7� DESCRIPTION OF WORK S=ELDIN6 .22��.c� RO MS O EXTERIOR WALL ROOF COVERING StIICCO COVE USE OF BJJILD}MJd AND WORK TO B Rock �w/Z=Vi"rC —^-...1`CGf Q/j,i�,v ' _ 1 H8P8BY ACKNOWLEU06 TNAT N VB qHAD TXIB APPL�C�TION AND eTATE TX�T TN8 �BQyg 18 CORR6<T AND AOp¢E TO COM. PLY WITH ALL CITY OR INANCEB ANO 9TAT8 U1N 9 R80ULATIN 6WLOINaGON8TRO411 N. SIGNATURE J � � PERMITTE AIITHORIZE�AGENT / T L80AL �_ � F E RECEIVED �� MAR 1 2 1963� FINANCE DEPT. APPUCATI�T�C�FP�bI� IHESA BUILDING Cor Office, Use Only peCe1P� NO. . PE9MIT NO. _ AT8 RBCEIV__-� / / /p l TYPE � ROUP � ATH NING U6E OR NH I BYILDINO ^ ;r U� l d- 2"(^� � . % �.MAN6 A/� LLB�E�LE�SST YARDSAPPROVED YARD9AP MAIN BUIL'DIN(3 AGGESSORY iOM C/L E ]NT FY. '�rJ � fi il �. � � �ina � cr � � � / c� DI6TANC8 BET. I BET. 1 'MAIN BL�OB. AGGE VAR.SC DATE TXe AMOUNT BXOWN UNGEq VALUATION 19 FOq TX6 PU0.P088 Op E8TA9LIBMINO A PEHMIT PEE ONLY.