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HomeMy WebLinkAbout115 MORRISTOWN LN - Building Permits Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. 6 -f-0 f0 CITYOF COSTA MESA CONSTRUCTION-f� PERMIT T PER IT NO. TRACT NO. LOT NO. UNIT NO. t ' Project Address //.S MO.P/er 5- /UW.J LA-Ve" � 8342 6/26/86 5.00 TL Applicant's Mailing Address . . - �j/ ^�Q / TYPE OF CONSTRUCTION ❑'NEW ❑ ADD Li ALTERATION L I REPAIR - 1rs�.p4CONVERSION 10 DEMOLISH ❑ OTHER A.P. , Zone Owner's Name )724.41e-le�^15 Phone F Si'Y DESCRIPTION OF WORK/USE OF BLDG. - Address rzn r� - S Main Building: Accessory Building: Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING FOUNDATION U STRUCTURAL E Front '• Q Address .�-��/77 . ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL B Rear N Contractor's Name//7B /� 2d/J7/7/UL J 1C-Phone7'.1,7 -3170 ❑ OTHER /�.$( I PROJECT DESCRIPTION SQ. FT. OCCUPANCY IC Right N AddressityLicense(mailing) N 1 ���573/ /��-�/.� JiA�R/7C�/l'J S G g CON ST RUCTION TYPE VALUATION$ S Left City No. ZONE GRADING CU.VDS. ACRES R LICENSED CONTRACTOR DECLARATION _ Ping. Ref.# .- Parkiing Req./Provided E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: : Planning Notes: IVCD JUN �'��`s� M with section 7000) of Division 3 of the Business and Professions Code, and RECEIVED my license is in full fp/ce .n. effect. T License lass C- Lic• se e -- /74S-7 $ Date - - -• - Signatur (�SWF Lir: . - PLUMBING I FEES WORKERS'COMPENSATION DECLARATION Bar Sink Showers ELECTRICAL FEES I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink ' •3800, Lab. C-) dt-ci - Automatic Washer - Transformer 0 15-50 KW Policy No. PTa Y"� Company �✓rair �AJ-S- Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+ KW ' __Certified copy is hereby furnished. .G Certyied copy is filed with the cityvljflilding i ision�) J Bathtubs Sewer Connection Cooking Unit Meter pup 10 100 amps Date i- ON FROMift, App l icanOMPEN( /(- EXEMPTION WORKERS'COMPENSATION DECLARATION Clarifiers lets Solar Collectors Dishwasher Meter Dover 100 amps \ (This section need not be completed if the permit is for one hundred($100) or - Iess). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel I certify that in the performance of the work for which this permit is issued, I shall not employ any person In any manner so as to become subject to the Drinking Fountains Solar Tank Fan Motors DO-1 HP ❑1%-8 Workers' Compensation Laws of California. Date Signature • Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar ❑9-15 HP❑16-15+ 'NOTICE: If,after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures Microwave comply with such provisions or this permit shall be deemed revoked. - CONSTRUCTION LENDING AGENCY - Gas Service Outlets Water Closet - . Device Boxes QI hereby affirm that there is a construction lending agency for the performance q Pole Light of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors - / Water Heater t9'- 4O , Outlets Range Lender's Name - V Lender's Address - Kitchen Sink Water Service - . Switches Sign , OWNER BUILDER DECLARATION - - I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories - Auto-Wash following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal ;Standing Sections county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays ' Gor ❑0 5 KW ❑5-15 KW any structure, prior to its issuance, also requires the applicant for such permit eneratTrash Compactor to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains • the Contractor's License Law(Chapter 9(commencing with Section 7000) of . Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil ^ penalty of not more than five hundred dollars($500). I . U I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 r' compensation; will do the work,and the structure is not intended or offered 1 - - Reinspection Fee I $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES • - License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own Hood or Type I 0 - DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not intended or offered for Boiler sale. it however, the building or Improvement Is sold within one year of com- Canopy Type II 0 Zoning Approved By Date pletlon, the owner will have the burden of proving he/she did not build or Im- Duct-Under Ground , Building Approved By Date prove for the purpose of sale). - pry' • 0 I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System - Application Issued By Date CaSb-i h tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 0o-100,000 BTU 0100,000 BTUI SUMMARY OF FEES builds or improves thereon,and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $ proof of their Worker's Compensation insurance should be provided to me. - PLAN CHECK $ PERMIT 0 1 am exempt under Section B.& P.C.for this reason Firepl/Fact.BIt. ICBO# Fire DampersISSUANCE $ / 0 PLUMBING $ �S•� Date Owner Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $ l hereby certify that I have read this application and state that the above - ❑O-100,000 BTU DI 00,000 BTL • ELECTRICAL $ GRADING $ information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize repre- iPLAN CHECK 50% $ MICROFILM $ sentatives of t�ss city to enter up yyryry the above-mentioned property for inspection pyryqb43. _ r> / -r'�6 MECHANICAL Signature 7751 LL�Ni'.Ci Date(O $ TOTAL FEE $ 7 Drivers' License Or SS ,-,4-/-.... . Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ CMF 0865-46,rev.10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor _ CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location ' 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms ' 4. Electrical Conduit-Undrgrnd. - 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings - 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd.,Test 9. Water Pipe•Undrgrnd. 60. Backwash Lines, P-Trap, 0 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. Solar System-Final 16: Rough Electric Wiring 67. Fencing & Access Approval 17. 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. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank O Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED'SYSTEM FINAL 29. Insulation 78. FIRE PREY. 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: ,f I44-S7 LE-PT (4.7.4-3 L.Fo 34. Final Heating & Air Conditioning 4/Zy/g7 G' ` 45 peg t,3. 0.17C at 35. Final Gas Pipe-Test '9 36. Hood or Canopy 37. Final Factory Fireplace ('r 38. Final Plumbing ;•rte 39. Water Service-Final 40. Gas Service-Final 1/4 41. Solar Domestic-Final • 42. Backflow Preventer 43. Backflow Irrigation - - 44. Landscape Irrigation System; 45. Sound Attenuation 46. Handicap Regulations r 47. FINAL STRUCTURE &BUILDING 48. Special Requirements Completed 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No Date 110 PROJECT ADDRESS: NAME:ORESS: OWNER'S 115 MORRISTOWN LN SCAMINACI, JOHN UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO; B 069505 ADDRESS: 21222 AVENIDA PLANICIE PERMIT NO: B 069505 PLAN CHECK NO: N GOVT: N SUPP ; N EL TORO,CA 92630 CONSTRUCTION TYPE; V—N PERMIT TYPE: STR PURPOSE; ALT ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION ; T/O RESTH & REROOF W/eeni & HOT MOP SQ FT: 2, 508 ADDRESS: UNIT: • CLAIM VALUE: 2, 508 , 00 CALC—VALUE: OUP 2, 508 , 00 GROUP OCC : R-1 / PERMITTEE: STOUT ROOFING INC ( 310 ) 923-6775 ADDRESS: P 0 BOX 4309 COMMENTS• REROOF SLOPE SIDE W/COMP FLAT SIDE BUR SMOKE DETE, REQUIRED DOWNEY CA 90241 ******************x**************�r�ryL+tak�E�6****x3r****�6�rrar�k*3R**x36* *g******xa6****** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ON ING REQUIR EMEN TS 7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS CITY LI�C,['� .5x�9/ /�77 sTATELIC.: 402536 cuss: C 39 EXP; 10/95 Date: IIJpcJD�'1q signature: _ MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR; FT IN FRNT; FT IN REAR; FT IN Compensation lnuran£e oraceJ,tified copy thereof(Section 3800.Lab.C. LEFT; FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN POLICY NO.: D82269` J EXP.DATE: 05/19/95 COMPANY: AIG PARKING REQ: PROV; PARCEL; 41916206 ZNE: REF NO: ❑ Certified copy is hereby furnished. n(Certified copy is iced with the city Building Division. PLANNING NOTES> hp'I 41/ Ll, > ' Dale: �1)(g Applicant: 3636*********36******3636****x****36*x*36********36*36****x*******76*36**36***36***********36 EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT SERVICES REQUIREMEN TS . I certify that In the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. ZONING APPROVED BY DATE; Date: Signature- NOTICE: APPROVED BY : Code.y:If,gust making this declaration,wiyou should become this permit to the Workers' rempensation provisions of the Labor DATE; Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: DATE: 42;ptiwhich this permit is issued(Section 3097,Civ.C). ***************************** ** 363636*36x36************************** LENDER: xx ADDRESS: LEGALIZATION:N E E SUMMARY STRUCTURAL SEGMENT ;Y OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 54 . 00 . 50 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed . pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN SM I P/NON—RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not mare than five hundred dollars($500). ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the TOTALS----> 54 , 50 0 , 00 0 , 00 54 , 50 ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law 54 , 50 . 0 0 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If,however the building or REVENUE DIVISION TOTALS--> COLLECTED; 54 . 50 OVER/SHORT: 00 orimprovement is soldf sale/. one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SM I P/TOT GRADING PLAN—CHECK 00 for the purpose of sale). I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 54 , 5 ❑ and Professions Code: The projects with License Law does not apply to an owner of properly who builds or improves thereon ******************************************************************************* and who contracts for such with a contractor(s)license pursuant to the Contractors'State License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. IND I V IDUAL F E E BR EAKD OW N O I am exempt under Section: B.&P.C. Iorthis reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date•. Owner: SFR 2508 REROOF BY VALUE RESIDENTIAL NOZONE 1 , 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES 2, 508 , 0b 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from these provisions. Date. Applicant. aa.Gralzunaa.4417943A. .; T 54.50 I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction and he eby authorize representatives of this city to enter upon the above-mentioned 'x'D UP L.I C A TE RECEIPT# property for inspectio purposes. e� 01 00170523-00170524 TOT 54.50 Date: dD 6 t Signature6 DATE: 10/28/94 TINE: 12:35 Drivers License 1 Social Security a: 1641-4e White—Building;Green—code Enforcement:Canary—Applicant;Pink—Revenue:Goldenrod—Assessor WI CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit# Date Inspector APPROVALS Permit ?,` Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location • 2. Soil Pipe-Undrgrnd. _r, 53. Steel Reinforcement P.:Electrical Condoit UtilitykUndrgrnd; 54. Forms 14:Ekctrical Conduit-lfndrgrnd. 55. Electrical Bonding T. 5.'.Sfeel Reinforceiheit 56. Rough Plumbing & Pressure Test , 6.''Eiectrical UFER Ornd. 57. APPROVAL TO COVER-GUNITE , 7,:Footings - 58. Electrical Conduit-Undrgrnd. u .:..Foundation - - - 59. Gas Pipe, 0 Undrgrnd.,Test !' .. 9. -Water Pipe-Undrgrnd. _ 60. Backwash Lines. P-Trap, C 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 .1 64. Plumbing System - Final 14. Rough Plumbing - -_ 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric`Wiring �1 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electric-al-7 Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 1 20.-.Rough rectory Fireplace a Si c'` , rAPPROVA'LS Pecmit # - t.1 21. ues,in,Stf_, . I , * �' * F F -'CI • . d ,e - 70. Underground Hydro ,- 22. Ducts, Ventilating.* _ .+ • r71. Prod uct'P-i-tipihy DI Gas 0Oil M..* , 23'-Ga-Pipe`Rou�h & Test _ `y , _72. Underground Flush, _, * •• ":73:::Undergrnd.Storage Tank C Gas 0 Oil • 74. Overhead Hydro- 75:.'Dry Chemical . , ^ u: r ,� •t; , i 76. Diy Standpipe , , .,28. Lathing& Siding.: a "y : N -•• 77.:'FIXED SYSTEMIFINAL* " ip '29. Insulatgl - In, ; - : n ! I I• , 78.tiFIRE PREY. FINAL • - .- . . • ; . -•-!30. Drywalln, lailibg ;Yr -": '-' " - I ! I; : :-4 HEALTHiDEPT- REQUIREMENT • Br own it: .79: FINAL INSPECTION `, MIr80. FOOD CERTIFICATE ISSUED' ' i . ''Notes: k i s - o xi . ,. r -. 42. Backflow Preventer' 43. Backflow Irrigation' • • 44. Landscape Irrigatiop System- 11�°� 1. + .,f -: 7 :n+ „ 1- r .45.,Sound Attenuation• - .i- r-, E-, -, ` ' '� 1 ° . .. t'1 F tr _ • ., 746.firlandicap;Regulations J . , : i1 t,; - 47. FINAL STRUCTURE & BUILDING a7?-ls &- t : '" -'t" 48._FINALPLANNINGr r•r`: . ,: I i. • 'r1 :49.=Electric Release to Edison 1 i I� :1: _ -1 50. Gas Release to Southern California,Gas Co , 1; :, . 51. CERTIFICATE OF,OCCUPANCY' : - 3 • . .. No. Date OWNER $AN vm'PA AiTTT.nTNG f!OMPANY DATE (_1_�jl�. JOB ADDRESS 115 Monist• . .. e BUILDING PERMIT NO. 22 GENERAL CONTRACTOR 6Zii VALUE $ 12,635.00 AP No. LOT 330 TRACT 5)60 FIRE ZONE DESCRIPTION OF WORK res w/att ga] INSPECTIONS Signature _DAT GROUP Iga TYPE v ZONE Ft Soil PERMITS IISSUED Gas e — 0 SUBCONTRACTOR DATE NUMBER Roug�Water / . efric. 0 Air Cond. 0 Rough Heating ei7 r4 4 • . Sg is_ _55.4.P c, — Rough Plumbing Sia271� /lra,� .lii �/%I - /-/-&V cU C'/ — Miscellaneous / Prop. Sin. Line 0 House Con. I St. Swr. 0 Q.4 �//1/ /1 Cc C,- €..L• DEC 9 1963 40 b 9' py. Sprinkling System / /,/^ Construction Pole 4 IVB t� Underground 0 Power ,0 i Rough Wiring, ,9 f -•Z�,Y c'_ sJ7�-°-- z PJ y///lye .23v2% — Trenches to. Forms ' Steel Reinf. ❑ A Floor System -re _ 7 9 Bond Beam 0 Steel Reinforce 0 Sheathing __ p ), • [�LA(P Frame and Flashin&i / e� - ' Lathing—In 1W Out!(�7/ - o - �� Plaster, brown coat / C7 3 — Refrig. El Air Con. 0 Final P?annr„g Dcp$. Heating, Final r /, 7/607 p • .a• ti:l• r Plumbing Fixtures, Final / ZFinal Gaa Test�,�'� / 1. t'"'"b u.aElectric Fixtures, Final < S4Building, Final /. /j/ 4> Form 0U4.-5MY 3-6;i—S-B P riC..D�6R liPSr4PT---REQU1RFMFNTS • 223/ 3 FEE RECEIVED COSTA MESA BUILDING-SAFETY DEPARTMENT gjy. 1 A OM P.O.BOX S/7' COSTA MESA.CALIFORNIA FINANCE DEPT. I 11��II77yy ��]] r 7� (� For Applicant to Fill In Completely APPLICATIORIFF&QS� SA TYPE OR PRINT BUILDING For Office Use Only BUILDING 115 Morristown Lane ADDRESS RECEIPT NO. MIT NO. COSTA MESA. CALIFORNIA ///fff 22 1DATE a ED OWNER San Vista Building Co. t`.. JL'' //77(6 GGRECEIVE a DATE JUN 1 1964 BUILDING MAIL 1166 E. 58th Street ADDRESS ADDRESS FIRE CITY Los Angeles 11, Calif. No•AD 37187 ZONE TYPE j _GROUP L4Z- APPROVED OR ENGINEER Raymond Levanas eio'OR 370J.0 BY DATE r ZONING ( QQ ADDRESS 3432 Via Oporto. Newport Beach Z.. 3I ND.OP ` / D OF NG_ �'f ,jT(`�1 • • PLANE ¢ Loif �/ /[ ' CONTRACTOR San Vista Building Co. GAL Tract 51' Lot 30 V ADDRESS 1166 E. 58th Street DESCRIPTION Z1)/ Z CITY Los Angeles alt Calif4 A.P.NO. Cl-/ �`./ / j NOTE: NO EAVE OVERHANG SHALL BE LESS HAN STLIC.TNO. 192782 NQ. Al) 171R7 E TEL. 90'70 BIDER REAR P.L. EAVES SIZE NO.OF BLOCS. ALLOWED (U.B.C.REQUIREMENT) OF LOT 20 x 70 now ON LOT 0 YARDS APPROVED YARDS APPROVED USE OF MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. Mnr.r — !FROM C/L STREET)! I/ A SETBACK LINE FROM FRONT /f/M^ FT, v FT. CENTER OF STREET ] 11 REAR YARD SIDE YARD LEFT 0 I RIGHT 0 R.SIDE ©FT. FT. DESCRIPTION OF WORK L.SIDE 0 Fr. FT. yl NEW X ALTERATION) ADDITION REAR O FT. FT. DISTANCE BET. BET.MAIN A REPAIR MOVING DEMOLISH MAIN BLDGB. ACCESS.BLDGS. IBUILDING �r NO.OF ` tZ VAR.$C DATE ybrAl SIZE OS� '2 ( ROOMS l J STORIES 2C.U.P.JF �! `/ APPROVEDEXTERIOR WALL ROOFBYta DATE (yTJJCOVERING NStilo QAND0 I COVERING S`},jn�]p BYT-,?1 S ti USE OF BUILDING AND WORK TO BE PERFORMED /_ Rpcidpnrp t'-:s«f,-..F (� //r///J,eb a �.,// a N.GS // '� // 6Q.FT. –'/�ao O I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN DER VALUATION IS FOR THE •1 AND STATE THA HE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF EBTABL HIND A PERMIT FEE ONLY. O MMMM PLY WITH ALLICI ORDINANCES AND STATE LAWS REGULATING VALUATION �� r' O BUILDING CON RU ION. SIGNATURE OF PERMIT FEE $ j PERMITTEE �� ���� 63.5-- PLAN CHECK $ 21 'E 6 AUTHORIZED AG NT T• Tp TOTAL FEE $