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COSTA MESA BUILDING -SAFETY DEPARTMENT
P. O. BOX 917 COSTA MESA. CALIFORNIA
For Applicant to Fill In Completely
TYPE OR PRINT
BUILDING _
COSTA MESA. CALIFORNIA
1 MAIL
FEE RECEIVED
Lot 45, Tract 4204, Plan ItM
FINANCE DEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
RECEIPT NO. IaPERMIT NO.
BY I OATS RECE�YED/ I DATE
1 e"� h`.: «e Ma...+.. r,.....—+4 -. u.;'nD 1I,,;,0n0 COSTA MESA. CALIFORNIA I
NO. OF BLOBS.
SETBACK LINE FROM
CENTER DF BTw..T M, I REAR YARD V I
K
BUILDINGp ' „NO. OF
SIZE UIX51 I ROOMS
EXTERIOR WALL STUCCO (ROOF
COVERING COVERING
USE OF BUILDING AND WORK TO BE 1
Single faMily
i!/attached garage
II
HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM-
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION.
SIGNATURE OF
PERMITTE Y� MPSa T)P� MarAf I1PVPj nT1FIpnt C
BY
AUTHORIZED AGENT
FIRE
ZONING
ZONPu^I _ I PLANS 7�
BUILDING
LEGAL
(CENTER LINE ST.1
FRONT 111
FT.
—� IN
R. SIDE
4
I
FT.
IN
L. SIDE
�'7
FT.
-� IN
REAR
z/
J
FT.
IN
APPROVED
BY
///
W L It, w n
GATE_
Garage area 445 S F
Covered Porch 23 S F
THE AMOUNT SHOWN UNDER VALUATION IB FOR THE
PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
VALUATION
,1�
PERMIT FEE $
S 1!1,777.^^M PLAN CHECK S
F
TOTAL FEE 51.00