HomeMy WebLinkAbout368 17TH ST - Building Permits7r'
COSTA MESA BUILDING -SAFETY DEPARTMENT
P n ROY 1911A Cr1CTA MFSA CAI IFQRNIA Q989R
APPLICATION FOR STRUCTURAL PERMIT
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For Applicant to Fill in Completely — Use Ink Only
RECEIV BV PERMIT Q
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BUILDING //'y/q1 I '�
ADDRESS �K/ V ` I '
A.P. NO.
BUILDING969
ADDRESS / htg
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ENAN R��IGR..S t s-/�C, S O�CI P
UNIT OR
SPACE NO.
MAILING
ADDRESS
T�NO,r, f, LOT psi � 6
FY 1
BLK.
C. 1 I TEL.
CITY 1`�l NO.
NEW
ADDALTER
REPAIR
MOVING
DEMOLISH
CONSTRUCTION
LENDER a �'
BRANCH
OWNER
41
ADDRESS
USE O B LUE$ ,S ��nt`
OARCHITECT R ENGINEER ML1.O wt's `swZ-T. TEL
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ZONE TYPE GROUP r
ADDRESS
CONTRACT/O R, 1_s't-0&1,S
APPRO ED o�
—
BY DATE O
s� l t /
ADDRESS �-tP'( '�+L�Qj...0-t
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CITY N I NO(y�.} .1.17)
STATE--tCITY
LIC. NO. ��j� rLIC. NO.
APPROVED SETBACKS
SIZE
OF LOT
NO.OF BUDGS
NOW ON LOT
(FROM C/L STREET)
FRONT FT.
ESE OFG BLDG.
USE OF �¢�
Separate permits are required for -
electric, plumbing and heating work.
L. SIDE 4 F4.
REAR ,/ FT.
USE OF BUILDING AND WORK TO BE PERFORMED
PLANNING ACTION
U' L
aeraoveo
AwaovleD
DATE r/
I hereby acknowledge that 1 have read this application and state
that the above Information is correct and agree to comply with
all laws regulating building construction, and I shall not employ
any person In violation of the workman's compensation laws of
the State of California.i%
I hereby certify that I am properly licensed as a contractor under
the State of California Business and Professions Code, Division 3,
Chapter 9, and that such licenses are In full force and effect, or I
em exempt from the provisions of the State of California Business
and Professions CodDivision 3
�, Chapter 9.
Signature of Al/�.t �_
Permittee
SQ. FT. Zoo 0.
THE AMOUNT SHOWN UNDER VALUATION IS FOR
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
VALUATION
,at�j _
$
PERMIT FEE $ �
PLAN CHECK S .
TAX $
or
Authorized Agent Date
TOTAL PAID S S
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