HomeMy WebLinkAbout298 JOANN ST - Building Permits(714)754-5273 • Fax(774)754-4856
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
298 JOANN ST
FRONT YARD AREA
41908101
CITY OF COSTA MESA
BIIILDING DIYISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
PLUMBING PERMIT
Applicant: BECKER, WILLIAM CHARLES
Address: 298 JOANN ST
COSTA MESA, CA
owner: BECKER, WILLIAM CHARLES
Address 298JOANN ST
COSTA MESA, CA
Contractor:
Address:
Arch/Eng:
Address:
Phone: (949)631-1341
Zip: 92626
Phone:
Zip: 92626
Phone:
Zip:
License:
Phone:
Zip:
License:
1'
NUMBER
P99-00599
77 FAIR DRIVE, COSTA MESA, CA 92626
SCOPE OF PERMIT
REPAIR/REPLACE SEWER LATERAL FROM HOUSE OUT TO PROPERTY LINE.
ISSUE FEE
Backflow irrigation
Backflow Preventer
Bathtub
Clarifier System
Connect (Ice,Soda,etc)
Dental Units
Dishwasher
Drain, Floor
Drain, Rainwater
Drain, Roof
Drinking Fountain
Expansion Tank
Gas Earthquake Valve
Gas (7-4 ouilets)
Gas (Over 4 outlets)
Gas Repipe
Gas Service
Interceptors (Grease, Oil)
Interceptors (Sand Auto )
AMT
$23.50
$0.00
50.00
50.00
$0.00
50.00
so.00
50.00
$0.00
50.00
$0.00
50.00
50.00
50.00
50.00
50.00
50.00
$0.00
50.00
$0.00
QTY
FEE SUMMARY
AMT
Laundry Tub I Washer $0.00
Landscape Irrigation $0.00
P-Trap $0.00
Pressure Regulator $0.00
Process Piping (per 10 ft) $0.00
Receptors 50.00
Septic Tank $0.00
SewerCapforDemo 50.00
Sewer Connect $24.65
Sewer Private Line $0.00
Shower $0.00
Sink. bar $0.00
Sink, commercial $0.00
Sink, Floor $0.00
Sink, kitchen $0.00
Sink, service/mop $0.00
Spa (private) $0.00�
Spa (public) $0.00
Qn
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
COMMENTS / SPECIAL CONDITIONS
Status: ISSUED
Applied: 10/21/1999
Issued: 10/21/1999
ISSUED BY:
SumpPump
Swimming Pool
Trep Primer
Urinal
Vacuum Brkr Bkflow(1-4)
Vacuum Brkr Bkflow(5+)
Wash Basin
Wash Basin Set
Waste and Vent System
Water Closet (Toileq
Water Heater / vent
Water Piping (Insl or Rep.)
Water Re-pipe
Water Service
Water Softener
OTHER
VIOIATION
PLAN CHECK
REINSPECTION
TOTAL CALCULATED FEES:
AMT
50.00
50.00
50.00
30.00
50.00
50.00
$0.00
50.00
$0.00
50.00
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$48.15
QTY
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 9248, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order tor the work authorized under this permit to be considered legal, such work must comply with all applicable codes, antl all
requlred Inspaetlona and final epprovel must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
WORKERS' COMPENSATION DECLIIRATION: t`
I hereby aHirm under penalry ol perjury one ot the lollowing tleclarations:
❑ I have and will maintain a certificate of consent to selt-Insure for workers' compensation, es provitled for by section 3700 of the Labor Cotle, for the pertormance oi ihe
work fOr which �his permit Is issuetl.
❑ I have entl will maintain workers' compensatlon inswanca, as required by saction 3700 of the Lebor Code, for the peAormanca of the work for which this permit is issued.
My workers' compensation Insurance cerrier entl policy number are:
Carrier: Policy Number:
(7his section need not be completed I! fhe permit is veluetl et one hundred tlallers ($100J or less.)
❑ I cetlity ihat in the pertormance of the work for w�ich this permit is issueQ I shall not employ any person in any manner so as to become sublect to the workers'
compensation laws of Celifornia, and egree that if I shoultl become suh�ect to ihe workers' compensation provisions ot Section 3700 of lhe Labor Code, I shall forihwith
comply with ihese provisions.
Applicant SignaWre: Date:
WARNING FAILURE TO SECURE WORKERS' COMPENSATIIXJ COVEfiAOE IS UNL4WFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED
THOUSAND DOLLARE ($100,000), IN AODITION TOTHE COSTOF COMPENSATION, OAMqGES AS PfiOVIDED FOR IN SECTION 3]O60FTHE IABOR CADE, IMEFEST, AND ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARA710N:
I hereby aXirm iha! I am licensetl under pmvisions of Chapter 9(commencing with Saction 7000) of Division 3 of the Business and Professions Code, and my license is in full
lorce and eHect. Lic. # Cless k
ContractoYs Signawre: Date:
CONSTRUCTION LENDING AGENCV:
❑ I hereby aHirtn that there is a construction lending egency lor the pertortnance of the work for which t�is permii is issued. (Sec. 3097, Civil Code).
Lender s Name: Lenders Adtlress:
SignaNre: Dare:
OWNER-BUILDER DECLARATIONS:
I hereby aHirm that untler penalry of perjury Ihet I am EXEMPT FROM THE CON7RAC70RS LICENSE LAW for �he tollowing reason (Sac. 7037.5, Business end Professions
Code: Any ciry or counry which requires a pertnit to consiruct, alter, improve, demolish, or repair any struciure, D�or to its issuance, also requires Ihe epplicant for such permit
b file a signed stetement Ihat he or she is licensed pursuant Io t�e proWslons ot ihe Conirectoro License Ww (Chapter 9(commencing with Section 7000) of Division 3 of Ihe
Busineu and Professions Code) or thet he or she is exempt therefrom and ihe basis tor t�e allegetl exemption. Any violation of Section 7031.5 by eny applicant for a permit
subJects the appliwni to e civil penalry ot not more than IWe hundred tlollars ($500).):
❑ I, es owner ol Ihe property, or my employees with weges es their sole compensetion, WILL DO TME WORK, and the structure is not intended or oHeretl for sale (Sec.
7044, Business antl Professions Code: The Contractors License lew tloes not apply to an owner of properry who builds or improves lhereon, antl who does such work
himsell or herself or through his or her own employees, provitled that such improvements are not intended or offered for sale. If, however, the building or improvement is
sold within one year of comD�etlon, ihe owner-builder will heva the burtlen of proving that he or she did not builtl or improve for purpose af sale.).
❑ I, as owner of ihe properry, am E%CIUSIVELV CONTAACTING WITH LICENSED CONTRAC70H5 to construci the project (Sec. 70d4, Business end Professions
Code: The contractors License Lew tloes not apply to an owner of property who builtls or improves ihereon, and who comraqs for such project with a coNractor(s)
license pursuant to the Contractors License Lews.).
❑ I am ex8mppi� uq/d�e/r,/S� c�. �_� �
Signawre: --Q1.yLdd.6d611yi
Owner ID ventietl 6y tlnver's license.
❑ ves ❑ No
Business antl Professions Code for this reason:
�/� Expires:
Ventication ot Ownership by (type ot tlocument, i.e. - v�aPerty tax bill or tleed):
DIVISION OF INDUSTRIAL SAFEIY PERMIT CERTIFICATION:
❑ I hereby certlfy ihat no e:cavatlon five (5) or more feet In deD�h Into which a person is requiretl to tlescentl, will 6e mada in connection with work authorized by Ihis
permit, and Ihat no building strucNre, scettolding, felsework, or demolition or dismamling thereof, will he more than thirry-six (36) taet high. (Chap. 32, Gry 2, Art 2, Sec.
347, Tule e, Celifomie Administretive Code).
❑ As owner�builtler, I will not employ enyone to do work which woultl require a permit from the Division of Indusirial Safery, as notetl above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safery Permit Number:
CERTIFICA7E OF COMPLIANCE AND AUiHORVATION OF ENTTiY: I certiy under penalry of perjury that I have reatl this application and state Nat �he infortnation given is
wrrect. 1 agree to comply with all stete laws end city ordinances relating to builtling consiruction, and amhonze represematives ol the City of Cos[a Mesa to enter upon Ihe
ebove-tles i d property for inspection purpo es. I agree not to occupy or allow occupancy of any building authonzed 6y this pe it until tinal inspection.
�1,V.��.�.N. �' (_3o,c�.�, rol � � %99
Signature Oi Legal Owner(s) Date
AnNOr Authonzed Applicant
CODE �. INSPECTIONTYGE
1616 Fized System Final Fire Prevention
1266 , Pool Spa Final
200 Final Re-Roof
207 Final BIocWRetaining Wall
202 Final Factary Fire Place
203
204
2b66d6
Final Sign
Final Demolition
G9if. INTRIALS
COU I INSPECTIONTYPE
206 Final Mechanical
208 Final Plumbing
210 Final ElecMcal
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
!f AT_� INTITIALS
PflQIEtT POOflE55: � g g JOANN ST
, ,OWNEe'SNAME: HECKER, WILLSAM
AODPESS: BECKER DONNA
� 7.96 JO�ANN ST
COSTA MESA 92626
631-1391
ANCHIENGINEEfl:
RUOPESS:
NEG.NO.:
UNIT:
UNIT:
PEflMITTEE: �ONNA BECKER ( 714 ) 631—i341
aoosess: 798 JOANN 57'REET
COSTA MESA CA 9261.6
LILENSEO CONTflACTON OFLLRflATION: I �ereby aifirm ��d� I am Iicen5e0 un�er pmvisions o� Chapter 9 �commencing with Seciion
7000) ol DrviSion 9 al Ille Busin¢ss and Pmfessions COCe, antl my license is in full lorce and ellecl.
CITY UC.: STRTE LIC.: CtASS:
�ate: Signamrt:
WONNEflS' LOMPENSRTION OELUIBATION: I �ereby aflirm Ihai I have a cetli�iW ie ai Wnsen� lo sell-insure or a ce�ilicate o� Workers'
Comoenution Insurance. or a cenilieC copy tnereol (Section 3gpp, LaD. CI.
POLICY NO.: EXP. OATE:
'OMPRNV:
, CenilieA coOY is hereby lumished. ❑ Cetlilietl copY is liletl with the city Builtling Division,
Dale: Fp0lieanL
EXEMPTION FflOM WONNENS' fAMPENSATION OECUflRTION: ((his seclion neeA no� Ge wmDleleU il Ihe permil is �or one �u�W�etl (5100) or less�.
I cetlify Iha� in I�e pedormance ol �he work lor w�ic� this perr�i� i5 issued. I shall nol employ person in any manner so as lo b¢tame
subjetl lo Ine WOrk)R' fAmpensation Laws of Calitomia. , �/� '
�� � /�i�.r ./� /
y�: �L/ � 0 SignaWre: � /C
NOTICE: II, aller making I�is 0¢claratian. you 5hou10 Ue�ome SUGIe�� �o �he Workers' Compen5aiion pmvi5ion5 of I�e LaOor
Catle. you must fonhwilh cAmoly witn sucn Omdsions or tNs Derrttit shall ee aeeme0 revoketl.
CONSTflUC710N 1EN01NG RGENCY: I �ereby allirm inat ihere is a consimctian lentlinp aAency for ihe pertormance ol lhe vrork for
wnicn inis oermil is issue0 �Section 3097. Civ. CI.
LENOEfl:
RDOHESS:
OWNEP BWLOEN OBCLAflPTION: I hereby affirm �hal 1 am exempl Imm �he ConVactors' State license Law br �Ae lollowing reason
�Secti�n 7091.5 Business and Pmlessional Coae: Any cily ol �ouniy which requir¢5 a permii to consimct, alter, impmve, aemolis�, or
reoair any simdute. prior to its issuance, also repuires ine applicant for such permit to lile a signea statement ihat helsne is licensea
pursuant lo �Ae pmvisions ai the Conlractors' Siate License Law �C�apler 9(cammencing vnlA Section 700�) ol Division 3 0l the Business
anC Pmiessions Cotle) or thal he/sh¢ is e�empl lherelmm aq0 ihe basis �or t�e allegeU e�emption. Any violation o� $ecti0n 7031.5 hy
any aDP�icant lo� a permil subjects I�e ap0�iwni IO a civil p@nalry ol not more Ihan five �unGred Oallars (E500).
1. as awner ol the propeny or my em loyees Wiin waqes az iheir Sale compen5dtion, will Oo ihe woB, an0 ihe
❑ simcture is not inten0e0 or oiferea lar sale I�cuon 7pn4, Business ana Pmlessional CoEe: T�e Cantractors' State License Law
ooes nol apply to an owner ol a pmpeny who builes or imDmves ihere0n, ana wha Uaes sucn woA himsell/herseli or tnrou0h
nis ar Aer own employees, pmvideE tAal suc� imprOvemems are not intenGed ar oHereO for 5ale. Ii, twwever the builUing or
imD�ovemenl is soltl wilhln one year oi campietion, Ihe owner will have the EurAen of Dmving �e/s0e Ai0 not bui10 or impmve
lor ine purpo5e ol sale�.
I, as owner of the pmperty. am exclusively conirac�in7 wi�� Iicense0 con�mclors �o constmcl the Dmlect (Seciion 704a, Business
❑ anC Pmfesvons COAe: The ConVacbrs' Siare LicensC Law Oces no� apON to an owner of pmpeM who Ouiltls or impmves IAereon
antl who conlracis f�r sucA pmlects wi�� a coniracl0r(5� license pursuanl �o ��e Conlraciors' S�a�e License Law�. I am awarE
Ihat proo� o� Iheir Worker'S Compensalion in5urancB 5�oulU be pmvide0 �o me.
� I am exempt untler Section: B Ij 7� 4 4 B. g p. C.
io� mis reas �: ALL WORK BY OWNER �,=1"�'u`�%� l
0� �� OwnecV e(��`�
I ao hereGy cenily that I am aware ol an0 unAerslantl ine reqYiremenls of Califomia Nealin antl Salery CoOe Sections 25505, 25593, antl
2553< anG I�ai I or any �uiure builGing wcupanl wilUwill no� (n¢le ane) ne¢0 to compty xith SaiA s�ale codes an0 I�e reQuiremen�s lor a
permil br constmclion or mo0ilication �mm t�e Fir Ouali�y Managemen� Ustrici. NesiOential con9rutiion applicaiians are exempi irom
inese p�ovisions.
Daie: Aoplicanl:
I here0y cetlitylhal I have reaa ��is ap0licalion and 5�ale�AallM1e a0oveiniormaiioni5 correct.l agree lo comply with all ciry ana county
oitlinancesanGSlaielawsrelalingmhuilAinpcons�mciionandher nzerepresen�ativesollhisci� loenleru tneabove�memionetl
prap¢rty lar inspe ion purposes. .
�y�e: O SignaWre: �
o�iver's�aenseo�sa�aisecudiyr: �
�5anC6 W�i�e—Builaino: Green—GOEo Enlorcemenl: Canarv—Aoolicam: Pink—Revenua: GOltlenro0—Asseswr
... ,
;�: -.--� _.
�,,:, . �_, .
`�'� �� r•' �(:ITY- 7FYEOSTA MESA — BUILDING PERMIT PERM NO: E 05811`_
PERMIT NO: E°d�811�5 ' PLAN CAECK NO; N GOVT; N SUPP: N
CONST�UCT��ON T.Yi'E: V—N PERMIT TYPE: ELE PURPOSE: OTH
JOB nESC,RIPTION ; SERVICE UPGRADE SQ eT;
i
CLAIM�VA�UE: CP.LC—VALUE: GROUP OCC: R-3 /
COMMEN"P$�:•u`POSSIBLY NEED RELOCATION PERMIT
�*��****�r*�w�**����*x**��***��r*��*+����cx����+�x x�vx*�*�r****+�*****�*�r**x��*��t��xx��*�
' Z O N I N G R E Q U I R E M E N T 5
! S E T E A C K S
------------ MAIN HUILDING ---------- --------- ACCESSORY BUILDING ---------
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: 41908101 ZNE: REF NO:
PLANNING N()'I'ES>
�
1E ik if if k iF iE iF�lt k iF �E !F it if 3(� 3F iE iF iF if aF 3f �1F if )F # 1E N� ih �1f 3(� k �F iE iF �IE iF iF iF if fElE If� if !f !f # IF#� If iF fElE if 3f K� iE �1F !E i1� if iE it iF �'t #F i! 3f iF IE±f it if� it 1!� #(� 1E ih
D E V E L O F M E N T §„'E.,R V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY .`-, DATE:
BUILDINr, APPROVED BY : = DATE;
AFPLICATION ISSUED BY: ^C DATE: 7`��'Z
1E 3E iE 3E iE iE ik iE iE fF iF iE iE if ak iE if iF 1EiE if iF * if iF if iF if iE 3E �If iF'�F£3r'£'K'iFiF ib if
ff �IE 3E 3E if iF 1E iF iE iF iE M 7E iE K� iF iE iE if iE ih 3! iE 3E �1E iF iE �F i(� iF IF jE iF iF if iF ie iE iEiFiE iFlE iF iE # �F iE 1E * jF /F iF iE iE �(� if i!� k aE iE iF iE IE iP iE iF id if iF R�)h IF iE if if iF iF iE
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 18,50
SOt SMIP/NON—RES
PI,AN
ISSUE FEE 15,00
BUZLDING—DZt7—> PERMIT' ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 18.50 15.00 0,00 33,50 33.50 ,00
REVENUE DIVIS70N TOTALS--> COLLECTED: 33,50 OVER/SHORT: .00
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CFIECK
33.50
k iE 3f iE if if if iE iE 1E iF if if iF iF �E 1E iFiE iF )f i! iE iF iE ik �f �E 1k iF if ik if 3F iE i(� If iE iE �F d(� iF # lE ih �f• if !f iE d( iE iE # 3E iE if if if�jF iF IF iF # If if 9't �f k� iF iF if 3f M?F iF 3f� 3F 3e M�
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
ELE 1 SERVICES BELOW 600 V 6 BELOW 201 AMP 18,50
END OF FEES
�
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i•�ilu � i �; . . . - ., � "'
1R,50
.`
� POC SPA
ICONSTRUCTiON ANDPLANNING
APPROVALS Permit # Date `Inspector qppROVALS Permit # Date Inspecto.
♦
1. Temporary Electrical Service or Poie 52. Pool & Equipment Location •
2, $pil Pipe-Undrgrnd. � 53. Steel fleinfO�cement
3. Electrical Conduit Utility•Undrgrnd. 54. Forms
4. Elsctricai Conduit�Undrgrnd. 55. Electrical Bonding
5. Stee� Reinforcement 56. Rough Plumbing & Pressure Test �
6. Electrical UFER Gmd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. EleMrical Conduit�Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, rJ Undrgrnd.
10. Structurel Floor System 61. APPROVAL TO DECK
11. ProPerty Sewer Line & House Connection 62. Backwash & Receptor�Final
12. Sewer Cap 63. Heater & Vent-Final
13. Root Drains 64. Plumbing SYstem - Final
14. Rough Plumbing ' 65. Electrica6Final ,
15. Rough Electrical-Conduit 66. Solar System-Final
76. Rough Electric Wiring 67. Fencing & Access Apuroval
77. Raugh Wiring Sign 68. APPROVED FOR PLASTERING
18. Raugh Electrical�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAI
19. Rou9h 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 OOiI
23. Gas Pipe�Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank 0 Gas O Oil
25. Roof Sheathing 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 � 7g. FIRE PREV. FINAL
30. Drywall Nailing � - HEALTH DEPT: REQUIREMENT
37. Plaster Brown Coat " 79. FINAL INSPECTION
32. Elecirical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric I . . �;tes:
3A. Final Heating & Air Condltioning
35. Finai Gas Pipe-Test '
36. Hood or Canopy
37. Final Factory Firepface �
38. Final Plumbing
39. Water Service-final
40. Gas Service�Flnal
41. Solar pomestic-Final •
42. Backflow Preventer
43. Backt4ow Irrigat+on _
44. Landscape Irrigation System ,
45. Sound Attenuation
4S. Handicap Regulations �
47. FINAL STRUC7URE & BUILDING
48. FINALPLANNING
49. Eleceric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
��
'i€��3
COSTA MESA BUILDING DEPARTMENT
P.O. BOX 31�
COSTA MESA, CALIFORNIA
FOR APPLICANT TO FILL IN
BUILDING
ADDRE55
OWNER KQ
MAIL
ADDRE55
CITV NEW
�
ADD ._�5
CONTRAGTC
ADDRE55
IEGAL
DESCRIPTION
A.P. NO.
COSTA MESA. CALIFORNIA
Y L
Cal
,� -,
�� ��- � ,� ,� �Iti,�
;�,�� � � ;� , 5 �
Fl�lP,NCE DEP��S�
APPLICATION FOR PERMIT
BUILDING
FOR OFFICE USE ONLY
RECEIPT NO. pERMIT NO
I. RECEIVEO BV
�l/"'�
TEL. !1D OLLI�� BUILDING
R W Koll Const Co N'o:
SIZE
OF LOT
USE OF
EXISTING BLDG.
SETBSCN'IINE FPOM
CENTEfl OF STflEfT
23
COSTA MESA. CALIFORNIA
"` 8534 ZONE J PLANS � TYPE
NO. 1
rnEio OR 3GE�01 BVPROVE ��� DATE
_e,,._ 31G1 CORRECTIONS
NO.OF BL�GS.
SIDE YAR� RIGHT LEFT b
DESCRIPTION OF WORK �
NEW g ALTERATION AODITION
REPAi,. MOVING OEMOLISH
BUILDIN NO.OF [
SIZE � �ROOMS [J STORIES 1
E%TERIOR WALL i ROOF
COVERING BVlSCCO COVERING rock
USE OF NEW
a�n�nw� cinolo fnm rPsi.denCe & att 88T.
�
ISSUEC
.�:_
/� 9�p .�
I MEFEBY NCKNOWLEDGE THAT I X4VE REAO THIS APP�IC4TION PNp �/
STATE THAT THE ABOVE I9 <ORRECT PNO AGflEE TO COMPLY W!TH iLL /�
CITY OROINFNCE$ PND STFTE LFW$ REGULATING BUILOING CONSTRVC�
T���� VALUATI ON p
SIGNATURE OF . PERMiT FEE S J� �
PERMITTEE /
S/7 �� r PLAN CHECK S �b '
.J V �
AUTHORIZED AGENT _�/ � TOTAL FEE $ ��'�
� Mr
,;.