HomeMy WebLinkAbout2947 MENDOZA DR - Building Permits..... . . .. . .. . . ..... • "__-_•.._ Y�... �' ...�r. e.. .:�:.4 '. .. .� -�-..- r r ... „
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Fire Incident # h� b E— 'A MESA FIRE DEPARTMENT
Police•Incident # , � / c.�. BOX 1200 � � ' `t•; t
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' COSTA MESA, CA 92628-1200'�•�, -�., � . _ ,_
�, (714) 599-1113 " "_ '°�
y ��
RELEASE OF PROPERTY AFTER EMERGENCY INCIDENT
The Costa Mesa Fire Department, in the interest of the safety and welfare of the cc
assumed control of [}ie property located at %� ti 7 !! I�s N T'GZ A �(
The necessity for assuming control of the property was because of r I!�%- F
Pursuant to the condi[ions contained herein, as of �`=� I U (time) I. �J
to, and is to be under the control and [he respons'ibility of "rF N A N i
who is the owner O, owner's representative O, tenant (►%.
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�
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,
at , 7 / (time) "�L �'(date),
ffie subject property is released
YOU ARE HEREBY PLACED ON NOTICE OF TAE FOLLOWING CONDITIONS (Check applicable condiuons):
O A rekindle or an additional fire from a hot spot is possible. The Fire Depa�tment rewmmends [hat a fire watch, with a
means to extinguish hot spots, should be posted for 24 hours.
O The following utilities: elec[ricity O, gas O, «�ater O, sen�ing the property have been shut off. I[ is advisable to
contact the appropria[e utility company before restoring the service.
O The struc[ure may have been weakened by the incident. Until a sWctural survey can be made, it is advisable to keep all
, unnecessary people out of and away from the building.
O'• Buildings that cannot be locked or secured'by normal means must be secured by altemative means. Barricades and/or
fencing are required to prevent unau[horized entry. It may be necessary [o provide a security guard.
O Rebuilding and/or repairing [he damage will�require permits (e.g., building, electrical, etc.) from the City of Costa Mesa's
Developmeat Services Department, Building'$a}ery Division. They may be con[acted Monday through Friday between
ihe hours of 8:00 a.m. and 5:00 p.m. by calling (714) 754-5273.
O The Costa Mesa Fire Department and the Costa Mesa Police Department retain the righ[ to re-enter the property
(� at reasonable hours, should [heir investigation of this incideni require such recntry. i/
Other precautions/co,,nditions (specity): J:,, �'r (�%� -C.., .+.^,�slt J-K'-!.x� -�.�s?ts._ i�. a ,�• t /
( i � � `
v '. _,
The conditions listed above are not all inclusive. They are intended as guidelines for the City's Fire Department in exercising [heir
discretion in providing emergency assistance advice. ``
} �
Information concerning a copy of the report for this incident can be obtained by calling [he Fire Dcpartment Business Once at (714)
754-5106, Monday through Friday, behveen the hours of 8:00 a.m. and 5;00 p.m. /
� �, , �� � � �^,; _ �.
You may be entitled to a reassessment and subsequen[�reduclion of your,property,,tac as a resul[ of this incident. For further infonnation
contact the Orange County Assessor's Once ai�(71'4) 834- �727 � Monday through Friday; behveen the hours of 8:00 a.m. and 4:45 p.m.
�. +'.� "L- � /' � � A
The OWNER, OWNER'S REPRESENTATIVE„and/or TENANT shall protect, defend, indemnify and hold harmless CITY and its
elec[ed and appointed boards, officers, and employees from�any and altidaims'; liabilities, expenses, or damages of any nature,
including attorney fees, for injury to or death of any p`erson, and,for inju{"ry to any property, including consequential damages of
any nature resul[ing [herefrom, arising out of or in any way.connected w�th the negligen[ pedormance of this Release by ac[ or
omission, by or on behalf of OWNER, OWNER'S REPRESENTt�TIVE,and/or 1'ENANP, or resulting from any ��olation by
OWNER, OWNER'S REPRESEN'1'ATIVE, and/or TENAN'C-of any s[atute, law,�regulalion, or olher legal requirement.
� L � y 4.:�._ �v t, C' ' tct n� �/`; I .
r: Il_ � 1� iJ- L� --Date ''' � � 1r::.0
Signed: i'. 1 � Time
.
Owncr ( ) Owner's Representative ( f )' � Te �r (,(. )- I ` 'G ",; ', . �
' .. �r'� �
Costa Mesa Fire Department � , � `��
Signed: ' �` ' �i� � � ' � � �,c��3 � — Assignment 1 �� �`i F `( ..
,( ' % O�cer in Charge � �' �' f i� �; =
WFfl'fE-FIIiEADAfL\'IS'IRATION YELLOW-OWNEIUON'NER'SREPRESENTATTVFlCENM7T PLYI{--DEVEIAPAiF,IV'ISER�7CES/BUILDL`7CSAFETY
FCTaoonEss: 2947 MENDOZA DR
w,` xnme: HILL, TcENA SUZANNz
- nooaess: 2738 GANNET DR
� COSTA �ESA,CA
838-6677
AflCX/ENGINEEH:
ADDNE55:
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92626
PEG.NO.:
uNiT: CITY OF CUSTA MESA — BUILDING PERMIT J�h:R U; ii 5 bi
PERMIT NO: B 057062 PLAN CHECK NO: N G V"P: N S Y: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPUSE: Ai,'f
JO$ DESCRIPTION , TEAR OFP 6 REROOF RESDI W/3 PLY BUIL'I'—UP SQ rT; 9,999
uxit:
PENMITTEE: CRANK BROS ROOFiNG CO ( 714 ) 548-5569
ADUflESS: ILE] COMMERCZAL WAY
CU5TA MESA CA 92627
LICENSED CONTRRCTON OECLABATION: I �ereby allirm Ihat m licensetl un0er provisions of� ap�er 9(commencing wi�h Seciion
7000) ol Oiv�sion 3 of ihe Business anU Pmiessions Code. and y IicenSe is in full brce �if C
ciTv uc. 0 5 9 9 3 STqTE LIC.: O ss:
Oate: Signamre: _
WOBKE ' COMPENSFTION OECIABFTION: I �ereby ir i ihal I have a cetlificate ai tonsenl Io selbinsure or a cetli�icate o� Workers'
Compensalian U6y�a e. a�cenUie�j cQpY Ihereo e on 3800. Lab.
POLICY ND.: � a�—� / �`- `� E%P. OATE: 1 I O 1 I 9 3
COMPqNY: STATE FUND,-s/
❑ Cenifietl coOY is hereby lumished. L'J Certilietl copy�h ih ly BuildinA Division.
�[ �/� ��
,�a `"5ale'. ! ` APPllcan�/�� —_l�i � 7�
EXEMPfI N FBOM WOHREPS' COMPENSATION OELUflATI (ihis sttYion nee0 not De ampletea il l�e permi� is �or one hunEretl (E100) ar less).
I certity ��al m ihe pedormanw of Ihe work for whith �his permit is issuetl, I s�all no� employ any Derson in any manner so as to �ecame
5ubjeci �o Ihe Workers' Compensa�ian Laws ol Califomia.
Date: SignaNre:
NOTICE: II. a�ier making �his declaration. you shoultl Uecome SUDIec� Io �he Workers' Compensation pmvisians o� Ihe La6or
Cotle, Vou must farihwith comDly wi�h such pmvisions or �his permi� shall be tleemetl revoketl.
CONSTPUC7ION LENOING PGENCY: I nereby aflirm ihat Inere is a conslNction Iending agenty for �he peAorrtWnce ol Ihe work br
which Ihis permil is issued (Set�ian 3W7, Civ. C�.
LENDEN:
aooeess:
OWNEP BOILOEP OECLAflFTION: I �ere6y alfirm �hal I am exemp� �wm �he ConVactors' Sia�e License Law for the following reason
(Sedion 7Q3t5 Business ane Pwfessional Cotle: Any ciry oi couniy which reQuires a De�mil �o cons�mct, al�er, impmve, tlemolish, ar
repair any simcmre, prior to its issuance, also repuires ihe applicant for such permit m lile a signed statement ihat �e/she is Iicense0
pursuam �o the pwvisions o� the ConVacmrs' S�ale License Law �ChaD�er 9(commencing with Section 7000) o� Division 3 0� ihe Business
antl Pm�e55ians Cotle) or Iha� he/she is exempl iherefmm antl �he �asis �or th¢ alleged exempiion. Any viola�ion oi Section 7031.5 �y
any applican� for a permii suhlecis ihe applicant to a civil penalry oi not more than five hunAreO dollars (5500�.
I. as owner of ihe property or my employees vnih wages as Iheir sole compensation, will Ao lhe work, ana Ihe
❑ s�mcWre is nal inlentletl or oflered �or sale (Section 7044, Business and Pm�essional Code: The Coniractors' State License Law
Ooes noi applY lo an owner ol a property who builds or imD�a�es Ihe�eon, and who tloes such woB �imsell/hers¢II ar thmugh
his or her own employees, pmvitlee tnat such impmvemenis are not intentleA or offere0 for sale. V, however ihe builtling or
impmvemen� is solU wi��in one year ot campletion, �he owner will have Ihe 6ur0en ol proving he/she ditl noi �uiltl or impmve
for Ihe DurpOse ol sale�.
I. as owner at �he pmpeny, am exclusively conVacting wit� licensetl conVaciars to consimct the prolect (Sec�ion 7044, Business
❑ antl Prolessions Cotle: The Comracrors' Slaie License Law tloes not apply to an owner o� pmpeM who �mlds or imD���es Uereon
an0 who contrac�s �or such prolec�s wiih a conUac�or(5) license pursuan� to Ihe Conlractors' Sia�e License Law�.l am aware
�ha� D�ool of Iheir Worker'S Compensa�ion in5urance 5hou10 be pmvitled to me.
� I am exempt un�er Section'. B. 8 P. C.
for �his reason: .
Da�e: Ownec
1 ao nereby cenify inal I am aware oi ana unaerstane ihe requirements o1 Califomia Healih an0 Safety Cotle Sections 25505, 25533, an0
2553a an01ha1 I or any WWre builtlmg occupant wtlllwill no� (circle one� need �o comply wilh saiA s�a�e codes anA Ihe requirements lor a
permii tar conslmction ar motlifica�ion Iwm �he Nir �uali�y Management �i5Vic1. Hesitlen�ial consWclion applica�ions are eaemp� imm
Ihese pmvisians.
�ale'. Npplicanl:
I �ereby certity tha� I have rea0 ��is apDlica�ion an� slate thai ihe ve inbrma�ion is
orainances antl stalelaw5relatingta builaing consimclion an0 her uthoriierepresent
properry lorinspeclian purpose�
aI¢: /� Q � SignaWre'.
�er's icenseorSociaisearnyx:
�o comply vn�h atl ci�y an0 counry
l0 en�erLEOn Ihe above-menfiDneA
W�ite—Builtlinq-, Green—Cotle ENolEement� Canarv—Aoolicani; Pink—Revenue: GOltlenro0—Assnssnr
CLAIM VALUE:
9,999,00 CALC—VALUE; 9,999,00 GRUUP OCC; R-3 /
COMMENTS: RERUOF W/BUILT—UP ROOFING
+�*�*�c �*��-*�x-* �*��* x******� x��t��x**+c..K.x..��x*******�*�a*�**x***�c*�� �**�� � ��� K��c*�x�s�*
Z O N I N G R E Q U I' R E M E N T S
s E s B A c x s
------------ MAIN BUZLDING ---------- --------- ACCESSORY BIIILDING ---------
FRNT; FT IN REAR; FT iN FRNT; FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKZNG RE � PROV; PARCEL; 42252132 2NE; REF NO:
PLANNING N T'ES>
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D E V E L O P M E N T 5 E R V I C E S R E Q U I R E M E�Ni_T S
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ZONING APPROVED BY DATE; r"_%,
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B[JILDING APPROVED BY ; DATE:
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APPLICATION IS_ST7ED HY• `L llATF.; -.:.�v.4Zc��Zi
iFihif%�iEiF�]f1E%�iEif�ifiFiElEiEiEiflEifl(. . . .. . .. . . . ... . . .. �SFiElfiEifit1ti41(�k)f�� �'£''£�'�ir'3Fit*i(�
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LEGALT7.ATION;N F E E 5 U M M A R Y STkUCTI1RAL SEGMENT;Y
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BLDG PMT PLUNBING ELEC'R3C"s'MECHANIC FIRE SMZP/RES GRADING
PERMIT 72,00 �- �'� `
� � ,%" SMIP/NON—RES
ZSSUE FEE ' � ���
BUILDING—DIV—> PERMIT ISSUE PLAN—�HECK TOTAL PAID DUE
•roTALs----> >z.so o.o0 2,�� ,;T;o.00 �z.so rz.so .00
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REVENLJE UIVISION TOTALS--> COL'�,ECT'ED• 72,50 OVER/SHORT; OU
BLDG�ZPOT� PLUMBING ELECTRIC MECHANTC J FIRE SMIP/TST� GRADING PLAN—CHECR
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�1E1F�FifiE#ifiFiEiE�fiF�7klfiE3fikjfiFifiE�lfifitlfiFifiEifiF3Eififik�Eik�NiF�kiF-1F'iP.jE3FiEiflEiF#iEiE�)f#if�ikif�lEiFY.�3E1kiEiFlElflF1e1F3FiE1F)EiF �
I N D 1 V I D U A Lt '�F �E"E, 7 B R E A K D O W N
TYPE QTY D E S C R I P T Z O N'M�. ,� UNIT COST TOTAL COST
SFR 4999 REROOF HY VALUE RESIDEN'CIAh; N020NE 1.00 9,99q,pp
ENDL OF�: FEES
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�COnSTRUCTION AND PLANNING
`'APPROVALS Permit #
7: Temporary Electrical Servi%�or Pole .
�
2. Soil PiOe�Undrgrnd. ✓�� .
3. Electrica� Conduit Ut(lity-Uqbrgmd.
4. Electrital ConduitrUndrgmd� �
5. Steel Reinforcement � .
'6. Electrical UFER Grnd.
7. Footings /� -'
8.- Foundation � f^ �
9. Water Pipe-Undrgmd. � ��
il' -
70. Structural F�oor System �.
71. Propertv Sewer Line & Housg.Eonnectior
i
72. Sewer CaP � i -
r�
73. Roof Drains -�� /
14. Rough Plumbing /.'�� /� �
15. Rough Electrica6Conduit '
i6. RoughElectricWiring �
17. Rough Wiring Sign
18. Rough Electrical-T Bar Ceiling
19. Rough Heacing & Air Condi2ioning
20. Rough Factory Fireplace
21. Dutts, in Structure ' -
22. Ducts, Ventifatin9
23.-Gas Pipe-Rough & Test ,
24. Roof Framing . � �
25. Roof Sheathing
26. T�6ar Ceiling (Structural{ & Monocoat
27. Frame and Flashing �
28. Lathing & Siding
29. Insulation
30. Drywall Nailing
37. Plaster Brown Coat
32. ElectriGal Power Meter-Final
33. Final E�ectric '
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood o� Canopy . .
37. Final Factory Fireplace
38. Final Plumbing
39. Water 5ervice-Final '
40. Gas Service�Final
41. $olar pomestic•Final
42. BackfloW Preventer
43. Backflow Irrigation - �
44. Landseape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
a7. FfNAL STRUCTURE & BUILDING
46. FINAL PLANNING
49'. Electric Felease to Edison
50. Gas Release to Southern California Gas C
51-. CERTIFICATEOFOCCUPANCY
Jo._ Date
A
Date
S
,
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POOLd A
Inspector APpROVALS Permit #
' S2. � Pool & Equipment Location
� 53. Steel-Reinforcement
54. Forms
" 55. Electrical Bonding
56. Rough Plumbing & Pressure Test
57. APPROVA� TO COVER�GUNITE
58. Electrical Cqnduit-Undrgrnd.
59. Gas Pipe, O Undrgrnd., Test
60. Backwash Llnes, P-Trap, O Undrgrnd.
. 61. APPROVALTODECK
62. Backwash & Receptor�Final
63. Heater & Vent•Final
64. Plumbing System � Final
� 65. Electrical�Final
66. Solar System-Final
67. Fencing & Access ApProval
' 68. APPROVED FOR PLASTERING
� 69. POOL/$PASYSTEMSFINAL
FIRE DEPT. REQUIREMENT
- �APPROVALS ' Permit #
��
Date � I
70. Underground Hydro
71. Product Piping OGas OOiI
72. Underground Flush .
73�. Undergrnd. Storage Tank � Gas ❑ Oil
74: Overhead Hydro
75. Dry Chemical .
76. Dry Standpipe � ' - �
77. FIXED SYSTEM FINAL �
78. FIRE PREV. FINAL
HEALTH�DEPT. REQUIREMEN7
79. FINAL INSPECTION - -
80. FOOD CERTIFICATE ISSUED
Notes: / •1_4t/a.. /."' _ _ 7T •
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orc1���� end 1��tLt;�z�i�.r, tes�od: T' ��ou ueod t�cidS.�i.oncil 1r�rc,rn;ation
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Cify of Costa Mesa
6uilding SafeTy DepprtmenT
. . P. O. Box 317
� Costo Mesa, California
CERTIFICATE OF OCCUPANCY'"�N�' I�9O C
The Building lomted aT �'� ����► ��a � ���T%— —
has been inspected and found To comply wiTh the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group ���' Occupancy. �
Use of Building �htxxRliRR i;mstl.C98?7tNt9 [34��1 ad'�kFSC"146$ .�42"k�3� __... ---
Legal Description � + F�ij ��'�'—�� .. , . � .
� (See reverse side for MeMs and Boonds)
Building Permit No. �,� Elecirical Permit No. 1��'�� Plumbing Permif No. �� � —_
�� Floor Load Signs have been installed as ��
required under Sec. 2308 U. B. C.
Room CapaciTy Signs have been in"sTaled as ��
required under Sec. 3301 (1) U: B. C. _ _
17050. CERTIFICATE OF OCCUPANCY. (a) No apartment house, hotel, or lodging house shall be �sed or occupied
.unTil the owner or operator has been issued a.valid certificaTe of occu�pancy by the� enforcement agenry. .
(b) A new certificate of occupancy shall be obtained whenever there is a change. in: .;
i) Occ�pancy classification of a building or portion Thereof � , .
. � � 2) The number of apartmenfs�orguest rooms, � � �� � ���� - �• • � � �
3) Ownership . . � - ,
ff Group H Occupanry, number of apdrimen4s� and/or guest rooms as' required under Sec. 17050.1' (d), Califomid
�Administrative Code, Ti11e 8, Chapter 9, Artide S. .. ,,.
Number of apartments—�— and/or guest rooms
ISSUED TO:: ' Building Officiql
m t 1f�,n Anmrcael9 FS�te���r�f t^+�a bY__� -_ j'yl c—
' .. � Date_ � � — � G �.
� 7his CeMificpte of Occupancy SHALL BE posfed in a conspicuous place on }he premises and SHALL NOT BE removed
except by the Building Official of the Cify of Costa Mesa under. Sec. 306 (e) U.B.C. Fo,,,� sw.�im—n-w--s-s r
OWNER
GENERAL CONTRACTOR
AP No. LOT
I*"'PECTIONS
Gas
coat
TRACT
0
2 BIR� ZONE
DATE GROUP
DnTE BlAR 1 2 1963
BUILDING PERMIT NO.
VALUE $ 4$,144.00
D�SCRIPTION OF WORKI}-
TYPE v ZONE
SUBCONTRACTOR
OCCUPANCY � �G�� /�� �y}' � I �
�ONM BU4 - 5M — 7�61 ' �
att.cp
..�-;��� ,$�-;� , FE RECEIVED �
COSTA MESA BUILDINGSAFETY DEPARTMENT �11,F� ' 1963
P.o.Bo=9,� =as=4MCaA,�A���RN�• FINANCE DEPT.
For. Applicant ro Ff11 In Completely APPLICA770�7�FOTL"�E1iM11`$A
� , TYPE OR PRINT BUILDING
BUILDING 2 4 MendP a� µ lve_ ' - For-Oiiice Use Only
AOOPE59 '
� PBCEIPf NO. E
COSTA MESA, CALIFORNIA i ��%_
R6C61 DBT OAT8R6 �VEO D�Tfi18911¢D
OWNER Dillman-Brummell Enterprises 3��3 M o
' = BUILDIN6
MAIL 12081 Buaro ADDRE59
ADORE58
FIRE
crrr Garden Grove No'S3o-ii6o =ONE rrae GROUP
� APPROVEO '
OR EN'GENEER W3�.t2T'S 8c .5017 No �ott 3-6�o BY OATE
ZONING
ADDREHS 4 6 Heliotro e Corona del Mar 1
_ ZON ..L PLANe„/ 0111LDIN eW '
CONTRACTOR Self ���
LeORL � � �
OEeCRIP�ION
ADDRESS ' � ,/'�� - �
�� A. P. NO. "C�
CITY
- ' NOTE: NO�EAVE OVERHAN6 SHALL BE LESS THAN
STATE TEL. _ 90" TO SIDE @ REAR P. L. �
LIC. NO. - N . ' �
SIZE � ,N ' EAVES ,
OFLOT � �ZCl.l .�4�owoNLOT O �+LLOWED (U.B.C.REQUIREMENT)
'YARDSAPPROVED YARDSAPPROVED
USE OF MAIN BUILOING � ACGESSORY BUILDIN6
EXISTING BLO6. '
( FROM C/L STREET) '
BETBACK LINE PpOM - FRONT Fi. FT.
CENTER oF eTtiEET �'�'S � REAR YARD S� ,
SIOE YARD I LEFT O. O RIOHT V� ' R. SIDE PI'. FT.
DESCRIPTION OF WORK �. sme , F-r. Fr.
�7 y,.
NEW ,� ALTERATION _ ADDITION REAR FT. FT.
DI9TANGE BET. BET. MAIN B
REPAIR MOVIN6 pEMOL19H MAIN BLOGS. ACCESS.BLD�B.
VAR. # DATE �
BUILOING 1� NO OF II
SIZE Y�X H� ROOMB LY' BTORIE9 �L C.U.P.#' APPROVED
EXTERIOR WALL ROOF APPROV 'Z � ��
COVERING StllCCO COVERIN6 Rock BY DATE J
USE OF BUILDIN6 AND WORKTO BE PERFORMED
4 unit dwellin with att. c s
f
� � � so. Fr. a m
1 HEREBY RCI(NOWLEOOE TXAT 1 NpVg RFAD TNIB APPL�CATION THE �MOUNT 6HOWN lINO6R VALUATION I6 FOP TH8 8
AND 9TATE TNAT TN6 ABOVE 18 CORFECT ND AONEB TO COM. PURFO6E Op EBTABLISXINO A PEqMIT FEE ONLV. �
PLY WITH ALL CITT ORD If11NC88 � A E LAWe REOULATINO � VALUATION
BIIILOINO CON6TRUGT � ' ^� y.s �^ N
PERMIT FEE $ I 'T `�
SIGNATUREOP = ��J -� m
PERMITTE a�)/ /�� pLAN CMECK $ 69 LL
✓
AUTHORIZED AGENT � 7
TOTAL FEE S �� / �
JOk
� GEI
ro AP
� 1�,�
3 '
o Gn�
— In
P
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Forms ❑ Steel Reinf.
ca�arr, iwvzrr_o.
Mendoza ITr.
VALUE $ 1C
UESCRIPTION OF
SUBCONTftACTOH
JAIV o �""
�
PpJ��r�,�� . 2s�;�
' ;�COSTA MESA BUILDING-SAfETY DEPARTMENT ,
P.O. BOX 017 COHTA M6HA. CALIFORNIA �
For Applicant ro Fill In Complefely
TYPE OR PRINT
BUILDIN� "� np_ �
AODRESS � T
�COSTA MESA, CALI ORNIA
MAIL py
ADDRE9S 7—/ T Ej✓
c�n CtifT ES
ARCHITECT
ORENGINE6R
�--
AD�RES3
CONTRACTOR
AODft889 '�—" '
CITY �-
STATE 'I
LI0. NO. �
SIZE
OF LOT
USE OF
EXISTINGBLDG. LCCX
SETBACK LINH PROM
��
DESCRIPiION OF WORK
NEW ALT6RATION ADD
REPAIR . MOYIN6 DEM
BUILDINR � . NO.OF
SIZE ROOM9 1
EXTERIOR WALL I ROOP -
COVERING � COVERIN6
USB OF BU I LDING AND WORK TO BE PfiRFOR
s
//
�
�
r-m��yr.c�i
FEE RECEIVEU
JAN 8 1965
FINANCE DEPT.
nPPuc.�Tc�rA �o�tO�T�;n� ESA
BUILDING
For Office Use Only
PHC81PTN0. I Pf1RM�LNO.
ZONING
NO.OF,� / UG60FN[W
PLANB y BUILDINO
��.�/'�
E OVERHAN6 SHALL BE LE55 THAN
YAROS MPROVED
MAIN BUIL�IN6
;OM WLSTREET)
VAR. �C
YARDSAPPROVED
ACCESSORYBUILDI[
BET. MAIN Q
ACCE55. BLI
OATE
r
� �� v o
so. �.
1 XEFEBY ACKNOWLED68 TXAT 1 XAVB RE�U TXI6 APPLICAT�ON TH8 I�MOUNT SHOWN UNO¢R VALUATION 18 FOR THe F
AND BTATB THAT TH! ABOV6 �B COFPECT AND AOREH TO COM� PURP08E 01 68TABLI9XIN0 A PERMIT FEE ONLY. 0
PLY WITH ALL CITY ORDINANC89 ANO 8TAT6 LAWG RHOULATIl10 yqLUAT1ON -. " � p
eulLolrvOcoNeiRUGT10N. ' .� ' �f pERM1TFEE S � j
SIGNATUREO _ ) m
PERMITTE � ' .r�2(Lrv '
S
AUTHORIZBD A6HNT , . $ , � � � L E �
�