HomeMy WebLinkAbout544 BERNARD ST - Building PermitsER va�v u� w[wx�x,
ADDRESS 544 Bernac
ERAL CONTRACTOR Ow
lo. 115-301-21 LOT
ECTIONS
R
H PLUMBING
. SWR. LINE MOUSE CON. ♦
IKLING SYSTEM
MISCELLANEOUS
ROUGH ME�TING ANO RIR CONDITIONING
TEMPORAqY SERVICE ON POLE
UNDERGROUNO � POWER �
ROUGH WIBIHG
TRENCNES FONMS �STEEL RE
FLOOR SVSTEM ��T_
BONO BEAM � STEEL REINFORCE �
SHE�THING
FR�ME RNU FL�SMING
L�TNING - IN OUT n
GL�STER.BROWN CO�T
STRUCTUR�L, :INAL
ME�TING, VENT., REFRIG. ANO �.C., FI
PLIlM91NG. FIN�L 1ND GAS TEST I-I
ynn L.
treet
DATE 1-24-77
SUBCONTRACTOR
�
�—�— AGP���ant ta �ill in atl
-�-cITV OP COSTA MESA PERMIT N(
• COlVSTRUCTION PERMIT Z �
Addl�
Convector
AddYess
within heavy bortler ilnes antl
33
all approp'lata tleclaratlor
lOT NO. �BLDG. NO.
' ' TYPE OF CONSTRUCTION
Phona ❑ NEW �.ADD ❑ ALTERATION
❑ REPAIR ❑ CONVERSION ❑DEMOLISH
LiCenSC NO. ❑ OTHER
DESCRIPTION OF N(ORK
I hereby affirm that 1 am Ilcens6d unaer �p�ovisions oT C�arter 9(com-
mencing witp 5ect�ort 7�p0) of Oiviston 3 of the Business a�d
Professlons Cotle, antl my Iltense Is in full forte and et/ect.
Llcen4e Class � Llcense No. -
Date � Siqnature
WORKERS' COMPENSATION DECLARATION
I hereby af/lrm tha[ I hava a c¢rtiflcate of tonsent [o sel�-in5ure or a
cenffiwte of Workers' CompensatiOn Insuronce, or a ce�tlBeC topy
theretlt (Section 3800, Lab. C.�. r
Policy No. � Cqmpany -
❑ CeYt�fletl topy Is hereby furni5hetl.
❑ CeYti�ietl copy Is tiletl with the city Bulltlln9 Division.
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Thli 5ection neetl nat be <omple[etl if the permlt is (or ane nunarea
SE3001 0� lessl.
certlfy that in che Performante of the work for whith lnis permit is
Issuetl � shall not employ any person In any manner so as to become
subjec� to t�e Workers' Compenzation Laws of Ulitornia.
Date Slgnature
NOTICE: If after making thls tleclaration, you shoultl become su0lect
to the Workers' ComPenSatton provisions of the l.abor Co6e, you must
tOrthW�th COmply witb SUCh prOvi5iOn5 or this Oermit sM1dll be tleem¢tl
�evOketl. - - . . . .
CONSTRUCTION LENDING AGENCV
I heretlY afflrm that there Is a construc[lan lentling a9ency lor [he per-
formaq�e of the work for whlcn Ihls permit I5 i5suetl (SecUon 309�
Civ. C.). - ' '
Lentlef's Ndme
Lentler's Atltlress
OWNER BUILDER DECIARATION � '
I hereby af(irm that I am exempt �rom tne Contractor's License L.aw for
Iha follow��9 reason'(Sec[lon ]031.5 Business antl Profesilons Cotle:
qny dtY or CountY whlth requires a perTit to ConSVuct, alter,
mproVe, tlemollsh or repair any stru<ture, prlor to its issuance, also re-
qW�es th¢ appUcva( to� SUCh pe�Tit to /il< a Sl9netl Stdtem0nt that he
Is Ilcensetl Oursuant to the provisions of the Contrac[or'S License Law
basl5 fD� [h¢ dllegetl exCmptlon. Any NOldlion of 5¢ctlon )031.5 by
any apP����t for a Permlt subjects [he applicant ta a civll penalty
�oyt, not more than five huntlretl Dollars (E500).
p�l, d5 owner of tnG property, Or my emplOyG¢5 wi[h wd9es as [hei�
sole compensation, will tlo the work, antl the 5tructure is not IntentleE
or o(feretl for sale. (Sectlon ]044. Business antl Professlons Coae: The
Conira«or's License Law aoes not apply to an owner of a Property
who bNlltlS or improves thereon, antl who tloes such work himselt or
[hrou90 his own emp loyees, provitlea [hat such improvements are not
Intentletl Or Otte�etl fo� sale. I(, howeve�, [h0 building O/ IrtiP�ovement
Is soltl wlthin one year oi completlon, the owncr will have the burtlen
of provipg ha tl10 not builtl of Irtlprove fo� th¢ pu�po5e Of sdle).
❑ 1, 2s owner ot the property, am exclusivety contracting with
Iltensed contractors �o construci tne projett (Section 7044, Business
antl PrOfessions Cotle: The Contractor's LlcenSe Law tloes na[ apply to
an owner of propertY who bulltls or Improves thereon, antl who con-
lracts /rom suth pro)ects wlth a contrattor(s� litesnatl purtuant to
the Coq<racror's Ucense Law).
❑ I arr� exempt untler Settion 8. & P, C. for this
reason
Date Owner
I �Br¢by c¢rtity t�at I have �ead Ihis applltatiOn antl statG tnat Ih¢ above
in(orm2tion Is correct. I agree ro comply with all city antl county
brtlinances.antl ztate laws relating to con5tructlon, antl hereby authorize
represe0tatives of this city to enter upon the above mentloneG
properri �or s cCion J�}� s _
Slgnature� �-'��U��- Da[e���JT
_......._______..�..,
CMF OB65�46 White-Builtling; Canary-Applicant; Pink-Ac[ounting;
❑ GRADING ❑ FOUNDATION ❑ STRVCTURAL
❑ TENANT ❑ ELECTRICAL ❑PLUMBING ❑MECHAN
❑ OTHER
PROJECT DESCRIPTION ._
SQ. FT. . _ •
OCCVPANC�'_CONSTRUCTION TVPE
VALUATION ZONE
GRADING CU. YOS. ACRES
PLUMBING � P�Ar�CHECK
BATHTUBS SHOWERS
TOILETS � URINALS '
LAVATORIES DOUBLE LAVS
KIT. SINKS DISHWASHERS
SERVICESINKS SUMPS �
FLOOR SINKS FLOOR DRAINS
DRINKING FOUNTAINS � �
INTERCE7TOR5 CLARIFIERS
SWIMMING POOL � P TRAP " -
WATERSERVICE ALTERATION
GASSERVICE ' OVTLETS �� �
WATER HEATERS � BTU OUTPVT ,� ,
SEWERCONNE[TIONS
SOLAR TANK COLLECTORS
SOLA0. PIPING SVS.
ISSUE FEE
MECHANICAL PLAN CHECK
HEATING SVSTEM 0-100,000 BTU
AND DVCTING 300,000 � BTU
REFRIGERATION 0-300,000 BTU
SVSTEM 100,000+BTU '��
BOILERS BTU
SVSTEM REPAIR, ALTERATION
EXHAUST SVSTEM MULTIPLE
ISSUE FEE
C
A.P. �
ZONE
REAR VARD (TO
PKG. SPACE REO.
STREET WIDTH
!ONING�REGULATIONS __ ,TL
� -•'
PLNTGpi gR�EJFL. � ` '
PROPE�RTY LINE .
�
�/L)
PROVIDED �
PARK FEE §
:DBV DATE
ONS:
+
. I
ELECTRICAL v�Arv CHECK
GENERATOR 0-1 KW_1-30 KW _
TRANSFORMER
'APPLIANCE 30-50 KW=50 r KW _
MOTORS 0-1 NP_1-10 HP _
(INC.SOLAR) 10�50HP 50+HP_
FIXTURES ' OUTLETS SWITCHES
GAS TUBE SIGNS
-POLE LIGHTS '
PANELS
SERVICE'
�
ISSUE FEE
•APPLICATION
MAIN SUB
AMP
DFTE
SUMMARV OF FEES �
BUILDING 3�%OU '
PERMIT E SMIP S
PLAN GHECK E PERMIT
PIVMBING $ /OOU �SSUANCE E
GRAOING 5
PLANCHECK $�_ , � ' $ . ' .
ELEGTRICAL $�
PLANCHECK $�� MICROFILMS
MECHANICAL $ �O � TOTHL FEE E
LE55 AD-
PIANCHECK E VANCEPC S-
j _ , . //�
FINAL FEE S `�'� OO
CONSTRUCTION AND PLANNING POOL & SPA ' � �
APPROVA�S Permit # Date Inspector qppROVALS - Permit # Date Inspector
�,
1. Temporary Electrical Service or Pole 43. Pool & Equipment Location �
Soil ipe-Un rgrn 4'1. Steel Reinforcement
Electrical Conduit Utility-Undrgrn 45. Forms �
4. Electrical Conduit-Undrgrn 46. Electrical Bonding - �
. tee ein orce 47. Rough Plumbin & Pressure Test '
6. Electrical UFER Grn 48. APPROVAL TO COVER-GUNITE
Footings 49. Electrical Conduit-Undr m
8. � Foundation 50. Gas Pipe, � Undr rn, Test
9. Water Pipe-Undrgrn 51. Backwash Lines P-Tra ❑ ndr rn
10. Structural Floor System 52. APPROVAL TO DECK
11. Property Sewer Line & House Connection 53. Backwash & flece tor-Final
�2. � Street Sewer Connection ' 54. Heater & Vent�Final �
Rough Plumbing '
�4. Rough Electric-Conduit �56. Electrical-Final -
16. Rough Electric-Wring "' 57. Solar SYstem�Final '
16. Rough Heating & Air Conditioning - � • encing & Access Approval
17. Ducts in Structure APPROVED FOR PLASTERING
1Q. Ducts, Ventilating
19. Gas Pipe-Rough & Test 60. POOL/SPA SYSTEMS FINAL
20. Roof Framing
21. Roof'Sheatfiin .
22. Frame and Flashin NOTES:
23. Insulation
24. Lathing & Siding
25. Drywall Nailing
26. Plaster Brown Coat
27. Electrical Power Meter-Final �
28. Final Electric -a � - ( ('..0 .
"7. Final Heating & Air Conditioning � � �
�. Final Gas Pipe•Test . -
31. Final Plumbing g�Qy L` - '
32. Water Service-Final ' \.
33. Gas Service-Final
34. Solar pomestic•Final �
35. Landsca e S rinklin S stem
36. Sound Attenuation �
37. Handicap Regulations
38. FINALSTRUCTURE&BUILOING ). -
39. Special Requirements Completed
40. Electric Release to Edison
41. Gas Release to Southem California Gas Co. � -
42, CERTIFICATE OF OCCUPANCY .
No Date
��q ' '�OSTR MESA BUILOING-SAFETY DEPARTMENT
�`� P.0-80.X�1200 COSTA MESA,CAL�FORNIA 92626
For Applicant to FHI in Completely — Use Ink Only
BUI�DING 5 yy��,�N�,��,
ADDfiESS .
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MAILING
ADDRE55
C�Tr [�
BRANCH
ADDRESS
ARCHITECT
ADDFESS
ADDRESS
CITV
STATE
UC. NO.
S12E
OF LOT
USE OF
E%ISTING E
TEL
NO.
TEI.
NO.
CITV
LIC. NO.
NO. OF BLDGS
NOW ON LOT
Separate permits are required for
electric, plumbing and heating work.
USE OF BUILDING AND WOFiK TO BE PERFOR�
I hereby acknowletlpe ihat I have reatl this application and r[ate
that the above Information Is correct antl aprae to eomply with
ell laws re9�latlnB builtllnB consttuetlon, enC I shall noc amploy
any person in �Iolation of Ma workman's compensation laws oi
Me Stata of Calitornle.
I hereby carUW tl+at I om vroperly Ikansed es e contractor undar
tho Stata of California Bustnau antl Protess�ons Cotle, Division 3,
Chepter 9, and thet cuch lieensas ere In full forca anC affeet, or I
am exempt from.tha provislons ot the State of Cnlifornia Businesa
antl Profassions Cotla, Division 3, Chapter 9.
Slqnature of /��j�� �/ (�
Permittea,<%��-`}'��✓ '
or
Authorizatl ABent Date � 2 q �0
.
� n59i iiz9ieo 76.00 TL
APPLICATION�FOR STRUCTURAL PERMIT
A.P. NO '
BUILDI G L
AO�RE55� �
VNIT OR
SPACE NO.
iR.NO.
�
NEW ADD
OWNE
USE
ZONE
APPROVED �
REPAIR�MOVI
VAWEs�y
CJ
^� �� �/ �
�i F�
./ l�
FT.
� /
ACTION
�7 DATE
APPROV
/t7�Lf _ nnTc /�
THE AMOUNTSHOWN UNDER VALU
THE PUflPp$E OF ESTABLLSHING A PERI
VALUATION PERMIT FEE $
V PLAN CHECK S
TAX S
TOTAIPAID E
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� � � COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX i200 COSTA MESA, CALIFORNIA 92626
Fot AppGcant to Fill in Comple[ely — Use Ink Only
HUIIDIN� �/ {n` �/ �) �
ADOHESS .`l l � /-+•F�^?/Yl'� /� !:
OWNEROR,�' '
TENANT (." �
MAI LI r1�
ADORE55 �
CIT V(.� O S T/J
ARCM�TECT
OR EuCINEER
ADDRESS
CONTPACTOR
ADDRESS �
CI7V �1y
�P�
TEI.
TEI..
NO.I.
i �
�.
APPLICATION FOR STRUCTURAL PERMIT � �•
RECEI V ED BV PERMIT � w+^ ^�
q.P. NO.
BUILDING
� ADDRE55
UNIT OR
SPACE NO.
TR.NO. LOT
��
NEW ADD ITER REPAIN N
owNEa .,i %�vN I �� �✓ I 1
�_.-.' � � - �
USEi.. .. . : � . . . � L� .,. V
!a9,- �
1
\� �
F STATE CITV NPPROVED SETBACKS
� LIC. NO. IIC. NO.
L OFLOT �-} -7 t � �y�� (FROMWLSTREET)
�1 i J
� USE OF
� EXISTINGBLOCa.ir:..f"�..
y
� Separate pertnits are roquired for
e(ectric, plumbing and heating work.
O REAR FT.
� USE OF BUILDIN6 AND WOAK TO BE PEFFORMED GLANNINO ACTION
� �� � �
� iil_ � .._.f ^ - -JC��✓t/• 'l '�1 � .. � APVIiOVED
� APPROVED .
r
�
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� I MnbY �knowbtl thet I heve ne0 Mb a
W eppll<etlon anE rtnu C
y� that Ma ebov� Informatlon U corr�ct end prw to comply wiM
� eil law� �pulatinp n�ueiop co�m��.ioo, .�a i meu �o<.�,aiov ,iOLD FOR SPECIAL REQUJREMEN7: ;
Zm any perwn In vloletlon of Me wwkman't eomp�n�etlon I�vn ot !�
� tiN Sbb ot C�4HMpl6
�-,; " m (�
1 h�robY cMlfy thet I am pfOOK�Y IIGpMd H O COOVCCtOI YlIEp ✓��SD' FT• n
M� SnU o1 Cali}ornls Bu�InHs end Profmlon� Cotla, Divlslon 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR ���;
C�epttl 9, and tAet weh IiunMs er� In full foru antl �H�el, or I THE W1RPO6E OF E.STABLISHING A GERMfT FEE ONLV: e�
em ex�mDt from M� D���dont ot M� Stan of Cslitornla Budnm
antl PrO��don�CoA�, DNlalon 3, C�eppt 9. VALU.�ITION PERMIT FEE S Ng� �'
Sipnatun o} �./ �/�� �.%' / . ..,. / I "7 �, D PLAN CNECK � � ^ o^• h;
Parmit[M - - �1lTi=f;� �� r TAX i f�.�
or ... . , .-'.�~/ S / �� � r ` � i
Author�ietl Aparit Date ' � �' U •� �•
_ TOTAIPAID f �� . �- ��
♦ . :
���,- . : �6
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BUILOING _/ /!/ � �
ADDflESS r yDe✓r�izrcr�)T
OWNER G �1/� L. U/i /
MAIL
ADDRESS / �1��
TEL.
cirv � � No.G 6 B �
CONSTRUCTION
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BRANCH
ADDRESS
AflCHITECT TEL.
GONTRACTOR ) �
ADORESS
TEL.
CITV NO.
STATE CITV
LIC. NO. LIC. NO.
SI2E i NO.OF BIDG�.
OF LOT (ap� J�a� NOW ON LOT
�.
VSE OF
EXISTINGBLDG. �n )SG
Separate permits are required for
electric, plumbing and hea[ing work.
USE OF BUIIDING ANq WOfiK TO BE PERFORMED
i�/l7ip� —u/�/—an�.v/r,Y/�✓..�
� \ / . / i= I i. � • � � 1
I hereby acknowledge thai I have reatl this application antl state
that the ebove information is correct antl egrea to comply with
all laws reBulatin8 builtlinB �onnruction, antl I shall not employ
any person in violatlon of tha workman's compansation laws of
Ma Siate ot California.
I hareby certify that I am properly Ileensetl es e eontracto� untlar
tha Stata of Californla Businezs end Profess(ons Cotla, Dlvlsion 3,
Chepter 9, entl thet such Iicenses are in full foree entl ettact, or I
am ezempt from the provisions of t�a Stata ot Callfornia 8usiness
antl Protessions Code, Dlvision 3, Chepier 9.
sieneture o%.� �'�/�� /f �i�
Permittee .� /
Authorizetl ABent
R
A
OVED
FA::.
. ,-r � r-�h��,..-p0i z�L,:: :„r�,�90.67
FORSTRUCTURALPERMIT
DATE RECEIVED nnrc icai irn
NO.Of �/ I USE OF
VARDSAPPROVEO
MAIN BUILDING
ROM C/L S=qEE
VAR.
FOR
TNEAMOVNTS
THE PVRPOSE Of
VALVATION
§�{s�
VARDS APPMOVED
CCESSORV BUILDIN
BET. MAIN &
ACCFffi. BLD
OATE
APFROVED
��r�' �.
PERMIT FEE y
PLAN CHECK S
TAX E
TOTALPAID b
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ON IS FOR m
FEE ONLV: "
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use�nk Only
BVIIDINGf�i/• w. .i�� �
OWNER
MAIL
CITV
BRANCH
ADDRESS
ARCHITECT
CONTPACTOR
ADDRESS
CITV
STATE
LIC. NO.
SIZE
OF LOT
TEL.
NO.
TEL.
NO.
CITY
LIC. NO.
NO. OF BLOGS
NOW ON LOT
Sepacate permits are required for
electric, plumbing and heating work.
USE OR BUILDING .�1ND WOflK TO BE PERFORMED
I hereby ecknowiadpa t�at I have raetl Nis appiieation antl state
that ih6 abova informetlon ia correct entl a0�ae to comply wiih
ell lawe re9uletinp buildinB eonttruction, entl I shall not employ
ony peraon In vlolation of Me wo�kman's compentation laws of
the Smto of Calitornie.
I hareby certify that I em prooerly IlcenuE ns a connector untlar
the Smte of Califotnia Butlneu onE Professiona Cotla, Olvialon 3,
Chapmr 9, antl that such Iicanses ere.in full force entl eftxt, or I
am exempt irom tha provislons of the Stata ot California Businass
entl Profaasions Cotle, Olvislon 3, Chapter 9.
Sipneture ot
Permlttoa
Authorixod ABent
icn'ta-���;�`00 9�+� vx�'''i75.Q0
APPLICATION FOR STRUCTURAL PERMIT
BUILDING
ADDRESS
LOT
�
VALUE
FIRE
ZONE
APPROVED
ZONE NO.OF
PL qN$
VARDSAPPROVE�
ROM C/L STRE
�
VAR.� DATE
C.U.P.�' APPRI
APPROVED
n
m
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m
SQ. FT, a
THE AMOUNTSHOWN UNDER VALUATION IS FOF m
THE PVRP06E OF ESfABLISHING A VERMR FEE ONL�': �
VALUATION P RMIT FEE § �� �
N
m
PLAN CHECK § �� "�
O
$ D TAX E �— LL
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. TOTALPAID §
COUN'I'Y OF ORANGE
._, BUILDING DEPT.
636 No. Broadway
Santa Ma� CaG(ornia
Phone: KI 2-6211
1. OWNER'S NAM:
MAILING ADDR]
Namc .... `�
Address ..._........_.._.
City . - --' -- ` " -'
S[ate
Lic No ....................
PROPOSED USE:
'
Application for Building Permit
AND FOR A
Certificate of Use and Occupancy
or Enginecr)
Name
Address
City
State
Lic. i
2. JOB LOCATION__....-- �� ... - - � i!<.��. -�/1.. .'���
.. .. ...... ..
(House No.) r q (Name of Screet)
3. LEGAL DESCRIPTION�: Lot.-_...l.-d.a---.....-.__---------------------Block
(Metes and Dounds Des<ription—Use rcverse :idc oI form)
Permit No.c � �.J.�v
Date.. _.__ •
. � ......./......�......��s"�.
�..... - --- -- PHONE :..................... ...�-----...
— .- CITY1.�dSLlTi(...� =-......
Phone........... ...........-- � - --
� L- i //L1�i��L�
- - ...... .............
�� ........................
or School District) 7
.....:........ Tract---1i�.....ti�2vJ...................--'
4. CORN�R LOT ( ) 1NTERIOR LOT (/' ) THROUGH LOT ( ) SLOPE OF LOT ( )
i. SIZE OF BLDG�.,3.�C.y.�..AREA:--- �1�1i-�--------SIZE OF LOT:.+�2..f-�'.�/..1E.r1..�w!�!ttREA:.....------ ....:................
i � Qp�— �,A D
6. HEIGHT OF BLDG.:..,�{�.. ...%.. ........CEILING HEIGHT:._�, ._ ..... NO. OF STORIES..!�!.`�5 ...............
� /LL ._.........
/ /
7. I�'O. FAMILIES___..� .................Sizc of Smallest Ecdroom:fQ_.x.�.�:.1�..__...._... Size of Kitchen..���..1i--� �'
.. -- ---- - �
� . �,,���%
8. EXTERIOR WALL CONSTRUCTIO . . --------- --.---INTERIOR WALL COVERING.. .. ..�i!�.c.v.c.�:�......
(Frame, Smeco, Etc.) �j� /� (PlasterDrywall, Em.�
9. SETBACKS: Front Yard From Center Line of Strecc---.----��.�l...---1.�...._L ......................................................_---..---------..--_-
/J¢ 7
Nearest Sidc Yard...���C�I.....Rear Yard��.���stance in Feet Between Bldgs. on Same Lot....n�:�C�
/ .. ..... --------------
10. A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STRUCTURES AND USE OF EACH.
11. For (a) Footing: Width...IT.%?�-------------------Dcpth in Ground.lC.-�"C.-..---.----Width of Wall..(t._ :'^..c..----...----'
Accessory �( ' / �
Bldgs. and �b) Size of Scuds:...��..�.Ll_�.........Spacing.l.� ..............._' CC Material of Floor.
Similar---------- ----�---...------------'-
Strucmres: ���j�
(c) Si:.c of Floor Joists:..�'�""`_"� ............._- -Spaung....-- .....-------...._- -_......:'CC
(d) Sizc of Rafters: ��.,�...�f`. - - ---....Spacing �- 2 7� s� ..............:'CC
12. VALUATION OF L'ItQB�JSED WORK: Induding al] labor, plumbing, electrical wiring, heating, fire sprinklers, painting and
sewagc disposal $.�.�..�_.Qs...Q..i�...---------_-
13. 1 HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN THIS
APPLICATION IS CORRECT AND THAT THE CONSTRUCTION WORK WILL CONFORM TO ALL LAWS OF
THE COUNTY OF ORANGE AND THE STATE OF CALIFORNIA APPLICABLE THERETO.
Plans Filed:
BIJg. Permit
Plan Check
Total - •
Receipt No.
Paid to -
FEES:
. �a
- �....-./ � -....
- S-........�...:�� -
� /�--�i...P-�...
�C ....��Q
Signed:
' ���tID�
(Owncr)
� !/Cuchorizcd Agen[)
7
FOR DEPARTMENTAL USE ONLY
�'
G ROUP.....�.._....-----
TYPE ... -- � -
DIST. _
MAP......._....- -- ; -
SHEET NO .............�...
DATE..........���...� /
sM-:.s�
CHE G BY
APPLICATI . _ . . HEALTH ............................
ZONING...._.. ..... FIRE
.. ...-
PLANS AND � � AR HAL .........................
SPEC'S. --- ..._.... �........... STATE.-�--- - - -- -- - ._...
CORRECTIONS /( ENGINEER
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