HomeMy WebLinkAbout2961 JACARANDA AVE - Building PermitsAoolicant to fill in all spaees except thosa wit�in �eavY �ortler Ilnos anE slgn all appropriate tleclarations.
CITY OF COSTA MpESA NSTRUCTION PERMIT PERMIT NO. � TRACT NO. LOT NO. UNIT N0. �
ProjectAddress �/G� ��/J�G�i���I'�'A•/��/� �L � �� �� �
AppliCa �['S Maili � Address �XLq! /Y• NYKC✓%C�, {t//I-qF1�✓N TYPE OP CONSTRUCTION NEW A�D ALTERATION REPAIR
Owner'sName i f}I� !O• N/E��OA� Phone ���Ly�� � CONVERSION ❑ DEMOLISH ❑ OT R- _ _ A.p.�6 20ne .
D SCRIPTIONOFWORK/USEOFBLDG.
Address �� ��"���NDeljC�,i2�" %.AG.inJA /i%jGU�.� �j �� d ' j S MainBuilding: F�ccessory8uilding:
U E 2
ArCh/Eng. LiCense No. � TVPE OF PERMIT G0.ADING FOVNDATION STRVCTVRAL T FrOnt ' p
Address
Q TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAI. A Rear N
r�7 �.�-��/��� O OTHEIi
Contractor's Name ��/�-TD f�n'Y)�iAl4 PhoneLl.f� _ C Right N
' Address (mailing) " .� PROJECT DESCRIPTION SQ. FT. OCCUPAN%V K Left G
/ COfVSTRUCTIONTVPE �� N VALUATIONS �� $
CityLicenseNo. n��(i -?�O 20NE GRAOINGCU.VDS. ACRES R
iICENSED CONT0.ACTOR DECLARATION Ping. Ref. � Parking Req./Provided E
I h¢reby attirm that I am Iicensetl untle� provi51on5 of Charter 9(commencinq Remark�: � ' PIdMiOy NOt¢5: ry�
with section ]000) ot Division 3 af tne Business ana Crotezsions Cotla, antl -
my litense is in (ull lorce anfl effeci. y'�' /, /� . � , T
LJCenSt CId55 G Lit nse !o. � Y S
Date-�-Z�-��/ 519�ature � j PLUMeING FEES
WQftn:ERS' COMPENSATION DE ARATI N Ba� Sink ShOwers ELECTRICAL FEES
� I bereby a111rm thal I have a cerU❑ ta ot consant lo self-insure or a cortlflcate �
f oi WOrkers' Compensation Insuran<a, or a cartltietl copy thereol (Soction Backflow Prevenrer Service Sink Automatic W85her Trensformer � 75-50 KW
N00. Lab. CJ �
No. ��� 7� Company ' Backflow Irrigation Sewer Cap Construction Pole Sub. � 50+ KW
ertifletl copy Is hereby furnlshetl.
C ifietl coy is filetl witn tne ciry Builtlin Divis' r BathtUbs Sewer Connection Cooking Unit Meter �up to 700 amps
Ddte�10�K� APPlicant -
EXEMPTION FROM WOfiKERS' COMP SATION �ECLARATION ' Clarifiers Solar CqlleCtors pishWasher Meter �over 100 amps
(Thissottion nee� not be tom0�e[ee if thc permit is for one nuntlretl (E100) or
(y,� less). Dishwdsher Solar Piping Dryers ❑Gas ❑Electric Sub Panel
��� I ce�Hfy Ihat in the pe�fo�mante 01 the wOrk fo� whlc� Inls perm�t Is Iisued, I
� snall not empioy any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fan Motors �0.1 HP �1 h- 8
WorkOrs' CompensatlOn Laws Ot CaliforNa. '
Data S�9�aturo � Floor Drains Swimming Pool w/Spe F,A,U. Inc.Solar �9�15 HP �16-75+
NOTIGE:If,allar-makinq this Oeclaration, you should become suDject to lha
� � Wo�kms' COmO¢n5ation OroNsionS o1 th¢ LdOor Code, you must forthwith FIOOf$i�ki U�iWI FiatU�25
comply with zuch provision5 or tnis Oa�mit Shall be tlaemetl rnvokod. MiC�Ow3ve
CONSTRVCTION LENOING AGENCV GasService �UII2L5 W2L¢�CIOS2t DCvic280z¢5
� 1 hereby altlrm that there Is a consVuction lentlln9 a9ency tor the performance Pole Light
of the work tor which Nis permit is IsSueC ($ection 309] CIv. C.) Int¢/C¢ptOrS Wdt¢r.H¢at¢r OUtI¢l5 Rdng¢
Lentl¢r'S Name
�.entler's Aaaress Kitchen Sink Water Service Switthes $ign, �- -
OWNER BUILDER �ECIARATION , ' - - '^�^'^' "�
I nereby afllrm that I.am eaempt trom the Contractor's License Law for the �avatories Auto-Wazh t _ �' - �
following reason (Sectlon 7031.5 Businoss ana Professional Cotle: Any ciry or Garbage Disposal �� ��Standing;Sections�� �� �<'•
county whicn rBquires a permlt t0 COnStruCt, alter im rove, tlemoliSh Or repair ]
any slructuro, prlor to its iszuance, also reqWres tf�e apo���ant for suc� permit P-Trap Wundry Trays Generator �0-5 KW �545 KW Tmsh CompactOr
t0 flle a signCtl slalem¢nt [bat he/sh¢ Is IlcenSatl pur5udnt lo lhe pfovl5iOn5 01 ROOf Dldi02
tbe Contractor's Licanse Law (Chapter 9(<ommendng witn Section 7000) of
DlWsion 3 of the Bustness antl ProfesSions Cotle) or that he/she Is exemD� - .
therefrOm antl Ihe basis for th¢ allegetl exemption. Any viola[ion of SoctiOn
7033.5 by any apPliwnt for a perTit subj¢Ctt Ihe applicant to a clvil
�enalty oi not more than five huntlr¢G Oollars (y500).
I, az owner oi the oroperty or my employees wlth wages as thair sole Reinspection Fee $15 laue Fee g 3
comDensa�ion, w�u ao tne work, antl the svutture is not intenEetl or olferetl - Reinspection Fee S15 luue Fee .$ 3
ror sale (Section 7044, eusiness antl Pro/esslonal Cotle: The Contractor's ' MECHANICAL FEES
License Law tl0¢5 not apply lo an Owner ol a proparty who builtli or impmves
tbereon, ane who aoes sucn work nimselt/nersetl or tnrou9h nis or nor own DEVELOPMENT SERVICES REQUIREMENTS: ,
¢mployoo5, prOvl�eC Ihdt zuch ImOrovOnlCnts are not inlentletl Ot offered to� BOil2� HOOd O� TypC I ❑
sale. I( however, [he Gulltling o� Improvemont iz soltl wlthin one yea� ot COm- . CdnOpy TypC I I ❑ 2oning Approved By Date
plotion, lho owner wlll have tho burtlen ot Proving he/ihe tlid not builtl or im- Duct - Under Ground Building Approved By Dat
�rOve tOr Iho Ourpose ot sale). ^�� _Q
I, a5 owne� ol Ihe properly, am exclusively Conlracling with IlcenSotl COn- DuCt -$truCtu�el pefrigeration System APpliption I55uad By Det o
Va<tors to tonstruct the project (Sectlon 7044, Buslness antl Professlons Cotln:
Tne Contrac[or's License Law does not apply to an owner of property who Duct � Ventilating ❑0-100,000 BTU ❑100,000 BTU SUMMARV OF FEES . j O
buI105 0� ImprOves [Itereon, antl wno contraCls to� such projects with a con-
vactor(s) iicense pursvant to the Contractor's License Law). I am aware that Exhaust System ❑ MWtiple 0 System Repair/Alteration BUILDING PERMIT $ �� �� SMIP $ h�
prooi o( tneir Worker•s Comoensatlon insurante shoultl be provitlea ro me. PLAN CHECK $ PERMIT .
1� I am exempt untler Section B. & P. C. tor this reason Firepl/Fact. Blt. ICBO � Fire Dampers PLUMBING § ' ��UANCE $
Date owner Heating System & Ducting egisters
PLAN CHECK 25% S - ENERGY P.C. $
I nereey certi�y that i have reatl thls appiication and state mat tho aoova ❑0.100,OOOBTU 0100,0008T ELECTRICAL § GRAOING $
intormation Is correct. I a9ree to comply wlth all clty antl county artlinanws
antl state lawt ralating to builtling c truttlan, an0 hereby authorize repro- PLAN CHECK 50%�$ M�CROFILM $
5¢niativei Oi tb15 City O e¢r n Ihu a00ve-mentlonetl proporly fo� . ro
Inspectionpurpo : �_��_�/e MECHANICAL S TOTALFEE $ (n�1
Slgnaluro Date��__f Reinspaction Fee $15 Issue Fee $� 3 PLAN CHECK 25% $
Orivers' enso or 55 �
CMF OBfiS-46, r¢v. 10/84 White - Bulltling: Canary - Applicant; Pink - Accountln9; Goltl¢nrOtl - Fsiasror ' �_� ��',,� �.�`_`�����":y �
J. _ i��/.l�v:� ._�,L .�: .
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspector qppROVALS Permit�h 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 UFER Grntl. 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, O Undrgrnd.
10. Structural Floor System 67. APPROVAL TO DECK
11. property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap ., .. . . . 63. Heater & Vent�Final
13. Roof Dreins •� 64. Plumbing System � Final
14. Rough Plumbing ' �65. Electrical-Final
15. Rough Electriwl-Conduic �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 OGas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Shea[hing $y?y� 74. Overhead Hydro
26. T-Bar Ceiling (Structuraq & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe ' �
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT �
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 60. FOOD CERTIFICATE ISSUED . '
33. Final Electric Notes:3..j,4. S
34. Final Heating & Air Conditioning 014 OFC�.) uQ ��--
35. Final Gas Pipe-Test �� - ' �
36. Hood or Canopy
37. Final Factory Fireplace g�y�-fj°) ,jMp�,E �p;�- OfL,
38. Final Plumbing . �
39. Water Service-Final .
40. Gas Service-Final
41. Solar pomestic-Final .
42. Backflow Preventer
43. Backflow Irrigation
� 44. Landscape Irrigation System �
45. Sound Attenuation �
46. Handicap Regulations • ,
47. FINAL STRUCTURE & BUILDING � �' .
48. Special Requirements Completed '�
49. Electric Re�ease to Edison •
50. Gas Release to Southern California Gas Co
-J
51. CERTIFICATE OF OCCUPANCY �
No. Date ' �8 , � •
Applicant to fi11 in all spaces witnin neavy Eorder lines an0 sign all aporopriate declarations.
CI OF COSTA MESA � PERMIT NO. TRACT NO. LOT NO. BLDG. NO. -
` ,l; NSTRUCTION PERMIT a /D �g22 /3�j �
Project Address TVPE OF CONSTRUCTION
OWner ,> P one �NEW ❑ ADD ❑ ALTEftATION
a
AddlCSS ❑ REPAIR ❑ CONVERSION ❑�DEMOLISH ' i PON,. REGU AT
Arch/Eng. License No.'� ❑ OTHER � �
DESCRIPTION OF WORK A•�.
Address I ZONE � � P�IyC�r F. �
� Contractor Phone S,p7 TVPE OF PERMIT �� ^ .i i ^ �^�� a B D�G
��-' 1 SETBACK $T. T LINE
C� Address ❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL LIDE VARD
�LICENSED CONTRACTOR DECLARATION � ❑ TENANT ❑ ELECTRICAL OPLUMBING ❑MECHANICA 5EDE V
I hereby afflim that I am Iicensetl untler provlsions of Charter 9(com- �� �; � RIGHT , '� �-
rtlencing with SECtiOn 7000) of pivlslon' 3 0( tna Buslne55 antl ❑ OTHER
Professions Cotle ana my Iicense is In full torce ntl effect. REAR VARD (TO P/L)
PROJECT DESCRIPTION .
V/�, LlcanseClasz ` icen No. PKG.SPACEREQ. � PROVIDED
" %'i�3'��I . . SQ. FT. ��� � .
Date� Slgnature STREET WIDTH PnRK FF_E S
WORKERS' COMPENSATION DE RATION OCCUPANCV ��O�yI RUCTION TVPE
I It¢r¢by afli�m that I havG d Ce�ti ' ate of con5¢nt to Sel/-InSur¢ Or a �",� ZONING APPROVED BV DATE
certifiwte of Workers' Compensatlon Insurance, or a'certltietl copy VAIUATION ZONE ���
[nereof (SecUon 3800, la�. C.). GRADING CV. VDS. AGRES SPECIAL CONDITIONS: �
Policy No. Company .
❑ Gertifi¢tl Copy is hereby turni5hetl. - REMARKS: ' .
❑ Certifletl copy is filetl wi[h the city Builtling Division.
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION -
(This section neetl not be completetl if tne permit is for one huntlrea _ �
(y100) or less). •
I ca�ti(y that in t�e per(ormanre oi the work for whiCh [his Oermit is
issu¢tl, I Shall not employ any per5on in any manne� so a5 to b¢Com¢ PLUMBING . PLAN CHECK ELECTRICAL PLAN CHEGK
subjact to the W rz' Compensation Law of C iifomia. . .-
Da[e '�'� � Signalure � BATHTUBS SHOWERS
NOTICE: I( atter niaking [his tlecl tlon, you snoultl become subject TOILETS URINALS GENERATOR 0�1 KW_ 1-10 KW
to Ihe WOrktrs' COmpenSatlon pro IonS of tlte Labo� Cotle, you muzt TRANSFORMER
forthwitn comply with suGh provi5i ns or this pmmit ihall be tleemetl LAVATORIES DOUBLE LAVS APGLIANCE 10-50 KW_SO+KW ' -
v¢vOk¢tl. ' " ' KIT. SINKS � � DISHWASHERS ' MOTORS pd HP_140 HP
CONSTRUCTION LENOING AGENCV �
� hereby aifirm lhat th¢r¢�is a ConslruGtlOn 1¢ntling ag¢ncy,for tne per- �$ERVICE $INK$ SUMP$ pNG SOLAR) 30-50 HP 50 + HP
formance of,the work�far w.nich�lhis permil is ;IssueO (Section.3097� - •-• � � � •
Clv. C.�. •. � ��� V.� ,�.\� FLOOR SINKS FLOOR D(3AIN5 FI%TURES OVTLETS SWITCHES
LentleCSName' - -
Lentler's Atltlrlss - �� • �� - . DRINKING FOUNTAINS � GAS TVBE SIGNS ' -
OWNERBUILOERDECLARATION a �� . INTERCEPTORS CLARIFIERS POLEIIGHTS
I herebybffirm•ihat I am�exemPt iroin the GontractorS,License law for' . -
the'following reason (Section 7031.5 Business antl Professlons Cotlei SWIMMING�POOL �PTRAP -
Any Uty dr_ wunty whicn requires a•permit to tonstruct, al[er; POLES METERED SUB
improve, demolish or repair any,structure, prioi (o its issuance, alzo re- yyqTEq $ERVICE � ALTERATION PANELS MAIN SUB -
quir2sthe�appliCant,tor such.perMi( to file a,5ignatl sWtemCM�[hal M1e � •� �
is licensetl pursuant to the provisions.ot the Contracto7:s License l.aw� .GASSERVICE� .OUTLETS SERVICE AMP
(Chapker.9•(cbmmencing withl.5ectioo�,]000),of.Division 3 of-the
Business antl Professions Cotle) onthat� he is exempYtherehom antl'the y.�ATER��H.EATERS r� � BTU OUTPUT '
basisQfordhe alle9etllexemption.;Any;vidlation�otp,5ection ]031.S;by
any applicant'for a permil zubjects roe appli<ant [o�a civll penalty `SEWER CONNECTIONS -
of not more Ihan five-huntlrea tlollars ($500): - ••�
�,I, as owner of ih¢,property, or my employees with wages as their SOLAR TANK COLLECTORS
sole aompen5ation, will tlo the work, anBthe structure is-not Intentletl '`' '''""
or offeretl for sale. (Section ]044, Business antl Rofessions Cotle: The SOLAR PIPING SVS. - ISSUE FEE '
Coniratior4 License Law tloes not apply to an owner of a property • - APPLICATION APPROV ED BV
who builtls or improves thereon, antl who tloes such work himself or ISSUE FEE OATE
[brougM1� his own employees, provitl¢tl tha[ such imptovemen[s are not
Mtentle0 or oiferea tor sale. Ir, howevaq tM1e buiitling or improvement MECHANICAL PLAN CHECK SUMMARV OF FEES
is soltl wi[hin one year o/ Complelion, lbe owner will bave the burtlen
of proving he ditl nol builtl o� improve to� lhe pu�pose of sale). BUILDING �� '
HEATING SYSTEM 0-100,000 BTU PERMIT $ O� SMIP E_� SO
❑ 1, as Owne� of [h2 prope�ty, am ¢xclusively ConVacting 'wilh qND OUCTING ,�O
li<¢nse0 conVaCtors to mnslrucl tne project (Sectlon 7044, Busines5 100,000+BTU PLAN CHECK E PERMIT
antl Pwfessions CoUe: Tne Convactor's �icense Law tloes no[ apply to � ISSUANCE b
an owner o( property wh0 builtls or ImprOv¢s lhCrCon, antl who con- REFRIGERATION 0-300,000 BTU PWMBING b '
tracts irom such prolec[s with a contrac[or(s) Ilcesnetl pursuant ro SVSTEM GRADING E
the Contractor's License Law). 100,000+BTU ^� �� � �PLAN CHECK S
❑ I am exempt unaer Sectlon B. & P. C. for this BOILERS BTU ELECTRICAL $ E
reason ' PLANCHECK g MICROFIWI $�
Date Owner SYSTEM REPAIR, ALTERATION ' TOTAL FEE 5
I hereby certiry lhat 1 have reatl tnis application antl stale that [he above EXHAUST 5�'STEM MVLTIPLE MECHANICA� E
PLAN CHECK $ LE55 AD-
informatlon Is correct. I aqree to compry wltn all tity antl county VANCE PC S_
o�tllnances antl state laws �elating to con5truction, dntl her¢by aulbo�ixe
r¢pre5entatives of thi5 cily to ent¢r upOn the above mentionetl ' '� eo
property for inspection purposes.
FINAL FEE $ ��
Signature Oale '
Drivers' Litense ar 55 � ISSUE FEE -
CMF 0865�46 White-Builtling; Canary-Applicant; aink-Accounting; Go�aenroa-�+.ssessoi
CONSTRUCTION AND PLANNING . _ � POOL & SPA' �
APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector �'
.,
1. Temporary Electrical Service or Pole 43. Pool & Equipmerit Location -•
Soi ipe-Undrgrn -' 44. Steel Reinforcement
3. lectrical Conduit Utility-Undrgrn , 45. Forms
4. Electrical Conduit-Undrgrn �.-' 46. Electrical Bonding
. tee ein orce � 7- 47. Rough Plumbin & Pressure Test �
6. Electrical UFER Grn � 46. APPROVALTO COVER-GUNITE
7. ootings ,a No�k�S C7 �'7- -81 49. Electrical Conduit-Undr rn
B. Foundation 50. Gas Pipe, ❑ Undr rn Test
9. Water Pipe-Undrgrn 51 . Backwash Li�es P•Tra ndr rn �
10. Structural Floor System 52. APPROVALTO DECK •
�11. Property Sewer•Line.& House Connection 53. Backwash & Rece tor-Final
12. Street Sewer Connection - � 54. Heater & Vent-Final
13. Rough Plumbing
14. Rough Electric-Conduit 56. Electrical-Final
15. Rough Electric-Wiring 57.� Solar System-Final
16. Rough Heating & Air Conditioning � encing & Access Approvai '
17. Ducts in Structure APPROVED FOR PLASTERING
16. Ducts, Ventilating . '
19. Gas Pipe•Rough & Test 60. POOL/SPA SYSTEMS FINA�
20. Roof Freming
21. Roof Sheathin 2�1
22. Frame and Flashin NOTES: \JQ,�.-fiG �e o
23. Insulation Q rQ G B h0 Q r . ,vQ �o
24. lathing & Siding p "Y P
25. Drywall Nailing g f' .
26. Plaster Brown Coat •-d 0-
27. Electrical Power Meter-Final O . :v�[
28. Final Electric ' S a � c /�o Lv�
29, Final Heating & Air Conditioning '7
30. Final Gas Pipe�Test 7�
31. Final Plumbing �` �
32. Water Service-Final '
33. Gas Service-Final
34. Solar pomestic-Final
35. landsca eS rinklin S�stem-
36. Sound Attenuation
37. Handicap Regulations �
38. FINALSTRUCTURE&BUILDING 7 L4 /
39. Special Requirements Completed
40. Electric Release to Edison
41. Gas Release to Southem Califomia Gas Co. -
42. CERTIFICATEOFOCCUPANCY
� No Date
��'� ,_�� �� AUG 7 1959
COSTA MESA BUILDING-SAFETY DEPARTMENT ' �
P.O. BOX 31� COSTA MESA. CALIFORNIA �
fOR APPL/CANT TO F/LL /N COMPLETELY aPP��canoN FOR PERMIT
TYPE OR PRINT BUILDING
BUILDING 2961 Jacaranda Avenue
ADDRE55
COSTA MESA. CALIFORNIA FOR Off/CE USE ONLY
OWNER nuazn$ AC*E9� Inc• I FECEIPT NO. I PERM`T
� .
MAIL RECEIVED BY OATE RECEIVED DA 'I :
ADDRE55 E• 1 t.Yl St.• /
CITV COSfia l�iesac� TNN•I 011 9 pDDkESS ��
ARCHITECT Carlson O[ LIC.
OR ENGINEER No. COST ESA. CALIFORNIA
ADDftE55 Garden Grove FIRE
ZONE
e o egrove, nC STATE 167293
APPROVED
CONTRACTOR LIC.NO. BY DATE
ADDRESS 419 E� 17ti�1 J�i� � Costa P4esa ZONING
LEGNL LOT
ZONE /� I NO. OF I USE OF NEW
DESCHIPTION No. 33 BLOCK TRAGT
/��l PLFN9 BUILDING
/
A.P. NO. APPROV D p /
BY / A DATE Vl
SIZE 60 x ll4 I��. �F a���snone �'ARDS EVES �
OF LOT J rvow oH �oi RE�UIRED ALLOWED
USE OF (CENTER LINE ST.)
EXISTING BLOG. FRONT FT.
SETO4CK LINE FROM GOi 43'
CENTER OF 6TREET l REAR YARD R. SIDE FT.
SIDEYARD ILEFT S� IRIGHT 5� �.sioe Ff'.
DESCRIPTION OF WORK __._ �y „ _ J
BUILDING NO.OF [
SIZE 1 6 ROOMS V STORIES 1
EXTERIOR WALIStuCC� IROOF shin le
COVERING COVERING .P�
USE OF BUILDING AND WORK TO BE PERFORMED
Single £amily residence with
attached garage.
� HEREBY ACKNOWLEOGE THAT � HAVE HEND THIB APPLICATION
RND 6TATE THFT TME A90VE IS COFRECT AND AGREE TO COM- 7HE AMOfINT SHOWN UNOER VALUATION IS FOR THE
PLY WITM ALL CITY OROINANCES ANO $TATE L/�WS REGULATING F'URPOSE OF ESTA9LISHING A PERMIT FEE ONLY.
BUILDING CONSTFUCT N. VpLUATION
SIGNATUfiE OF � ` :'ERMIT FEE $ 3Z��
PERM1IITTEE
$ 13�715 PLANCHECK $ �.6�00
/:_.
AUTHORIZED AGENT � p
TOTAL FEE $ �•�