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HomeMy WebLinkAbout1161 GLENEAGLES TERR - Building Permits,. ADDREsft BMLMNO: 1161 GLENEAGLES TR UNIT. OWNERS WYE IF MOWN LITTEN PAULA S ADDRESS: 1161 GLENEAGLES TEP. COSTA MESA,Ck 92627 714) 631-1161 APPL. MAILN0 ADDRESS: SAME ARCRRECT OR ENGINEER: MCH.OR EM'S ADDRESS: 11C NO.: CONTRACTORS NAME: CONTRACTORSMNLNG ADDRESS: LK. NO.: UNIT, UNT: LICENSED COW RACTORS DECLARATION: I hermy sham under panty d perjury Mat 1 am loaned under provisxrb d Chapter 9 (w arnmci g wah Section 70001 of Division 5 of Me Busimm end professions Code, and my Jim. b in lull faro and Nim, CITY I.C. NO.: LIC. CLASS: LIC. NO.: EXP Dae: contrm«: OWNER BUILDER DECLARATION: I hereby affirm under sanely of perjury that I an exempt from the Comrmom Lassoes Law Wr iM following reason (Section 7031.5 Business and Profession Cade: Any city «county afiich requires a permit to omahu 4, ab«, impress, nmlbh, or muss any mupure, par to its bamens, also requires the applicad for exit permit to fib a sipped statement Met M or she !iconsnd p Truant to the provisions d theContm«ma s License Law (Chaper 9 (comemkg dmon h Se700d 0) Dbbion 3 of the eines end Prdemions (kale] or [hot M a aro is exam! tharamm and IM bean I« the aleeed exempun. Any violation of Section ,031.5 by any applicant 1« a peamil subjects the applicant to a dvll penalty of int more than We hundred dollen j$50D]). ❑ I. as owner dihe popmy o my employees elfin wages as their wee wmmnsation, will do the %ss*. end the anxtum is nor intended or offered for sale (SecMn 7044. Busimwend Prolmsions Cme: no Common Liamas Law dons hat apply toes own«d PmpeM wine Imide or inproves tMreon, end wfio does such wok Nmself «Mrself or throgh his or her own mmploYeee, premed that such improvement. are m intsded or atered for sale. t, however. the building or mpoaement b add ailhin one year a completion. IM owmr4mider sill have IM Mdw d proving he or she dd not build or impom 1« IM purr,sae d sate). ❑ I, m owner of the pap", am exdmK%* conummg nth licensed cWtrectos to canamd the project (Section nwut Business end Prdesams Code: TM Comredom License Law does not apply to an owmr of property seta builds or impovm thereon and alto coneecb 1« encs projms with a cm md«(s) licensed pursuant to IM COntrmare License Lew). I ne.emtander�Jedi«1:BPQJ090w14 B.aP.c..forthissss(A��77���WNE BUI Data: /� / S eu: do hereby canny that 1 am aware of and uadarsbrd Bre reedmnems of Ca lomia Nwlth and Safety Code Sections 2550'5, ?5533, end 25534, and that I «my Mum Mitring oonopant will I will int (dmb Om) need to c«nply with said sbte codes and the requinemwb ler e puns[ I«conamdbn«modMmion hantMAaan apemenl Dietnct. Readentia commtlion appiratiomen exempt from thine mowsioM. Dae: Applicant: WORKER'S COMPENSATION DECLARATION: I Mreby affirm under penalty of perjury ons of Me following detlarations: ❑ I Mve harthe artmeren a a the s d oorwnt b set. -insure M mosnd rs c«npeneation, m peslded 1« by smlon 3700 a tM lobar Coda, t« the performenra a the eek for whkh Mils paint u issued. ❑ haus and viol work t« xhkM this paernmwore d . My snorers' commpor sa ioinumrebyceSmcarrier n aand! d Me Labor Code M IM Performarwe d IM pAiry number ars: Carder: Policy Number: .ds armor nem not, We c«npkbd r theamok b for «n hurdrad dollars /5100/ or loss.) ❑ I conty that in IM performance of IM eek ka aitch this parmil is issued, I Mail net employ any pnwn in any manner w as to become subWx no the amkars c«npereation awe of Canaria, and agree that B I shpuld Weems subject 10 the workers' compmcation provisions of Smion 3700 of the Labor Code, t shall forthwith oomph, with Mme proviabns. Date: Appicant Wamhrg: Falun b secure wake o'romPMaatlon rnvuage Is unlawful, and aha/ asi en employr he mWAW penaNlaa And ,IWI Nares W to ons hundred MMmmsof dollen ($1040001 M addition W the coat of rompmaalbrt damage, as povded for In Section 37M of Me Letter COW, Intent, and adoresy s leu. CONSTRUCRON LENDING AGENCY: I hereby aNns under penalty d prim, that there is e aarNmalon lording aDmm, for Me performance of IM wok for whihoh this permit Is issued (Session 3097, civ. C). LENDER'S NAME: LENDER'S ADDRESS: I certify that I Mve read this application cad nate that the above Information Is coped. I ague to campy with all dry and county ordinances end We lows relating to htldlog outs. ion anal hereby "horse repemntatNes of this dtto enter upon the abese-memione! property for tnspedim purposes. ULA LITTEAI not N _2-� e Dae: J Slgnaured nm enmppuuaU WvWsor (515146.WP) Whm-EoiMmg A Suety: Green -Rte: Cemry-APPYoent: Pink-Revsnm; G AdemolAseaeeor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 072014 PERMIT NO: P 072014 PLAN CHECK NO; N GOVT: N SUPP: N CONSTRUCTION TYPE: PERMIT TYPE: -PLU PURPOSE: OTH JOB DESCRIPTION ; REPLACE WATER HEATER SQ FT: CLAIM VALUE; CALC—VALUE: GROUP OCC: / COMMENTS: X {4#iF{{.#�FYA{##i!'il####i("N'il'if####a%"IF iI•iEi('i4#K###'Y�F###'1r-if if'###jf iF#ir'N#i.#iR-1FK#iF if t(.#'K-1F Jf if #Af iF 1F -1f iE#�P#Y"N-'N"N Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT: FT Ib] REAR: FT , IN FRNT: FT III REAR: FT IN LEFT: FT IN RGHT: FT:„ IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: 'PARCEL: 42233201 ZNE: REF NO: PLANNING NOTES> > D E V E L O P M E N T SSE R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY : DATE: APPLICATION ISSUED BY: /(� \ DATE: ###*###+t############ ##*aT: ;-k e"F1FiF'F, rt�""77vA* LEGALIZATION.N F E E S. U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTR1IC MECHANIC FIRE SMIP/RES GRADING PERMIT 7,00 258 SMIP/NON—RES PLAN t , ISSUE FEE 20.00 BUILDING—DIV—> PERMIT ISSUE PLAN'—CHECK TOTAL PAID DUE TOTALS ---- > 7.00 20,00 0.00 27.00 27,00 .00 REVENUE DIVISION TOTALS--> COLLECTED: 27.00 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 27.00 r I Dl D I V I D U A L' 'IF 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 1/11 PLU 1 WATER, HEATER AND/0RIVENT 7.00 7,00 END -,OF FEES _i i1 Gil rtU.S�i4b�—L1613Df,9i TCIT 27.00 DATe: €4/24/95 1'1?1E0 13:29 CONSTRUCTION AND PLANNING APPROVALS Permit q#- Date Inspector - POO .PA 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 UFER Grnd, 57. APPROVAL TO COVER-GUNITE ' 7. Footings 58. Electrical Conduit-Undrgrnd. '8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, O 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 l 64. Plumbing System - Final 14, Rough Plumbing _ i 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 APPROVALS Permit # 20. Rough Factory Fireplace - 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating - 71. Product Piping O Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrr d. Stor.age Tank O Gas 000 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 PREV. 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::-��^. 34. Final Heating & Air Conditioning t - _2 _p� i 11 • 35. Final Gas Pipe -Test 36. Hood or Canopy .�. 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer _43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING ' t. 48. FINAL PLANNING '-- 49. Electric Release to Edison ij 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No Date - ``--� CITY OF COSTA MESA BUILDING DIVISION OWNER -BUILDER VERIFICATION A city or county, which is required to give notice pursuant to Section 19830, shall attach to such notice, and, as a condition precedent to issuing a building permit, require the completion and require the return of, an owner -builder verification. Attention Property Owner: An 'owner -builder' building permit has been applied for in your name and bearing your signature. Please complete and return this information in the envelope provided at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. 1 personally plan to provide the major labor and materials for construction of the pro- posed property improvement. Yes ❑ No W I (have/have not) signed an application for a building permit for the proposed work. 3. 1 have contracted with the following person (firm) to provide the proposed construction: Name _ Address Phone ( City Contractor's Lic. No.. 4. 1 plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work: Name Address Phone ( City Contractor's Lic. No. 5. 1 will provide some of the work but I have contracted (hired) the following persons to pro- vide the work indicated: Name Address Phone Type of Work I hereby affirm that I have received a copy of the information set forth in Section 19830 of the State of California Health anj_Safety Code and have completed the above information to the best of my per- sonal knowledge, in ianc with thi t q Signed: //�/L t Date: S Name: i cLl��'r l7- L V-) (Printed or Typed)� 754-5273 '%PPLICATION FOR A BUILDING Pr 'IT Tract Block Lot BUILDING PERMIT NO. /� �j/1 47 (� Electrical Permit No. Building Address ` (j /lir /`� �S Plumbing Permit No. /' Cross Can ✓on �' Area (�p5%�j /q�,50 Street j C/r0 V_ /a Mechanical Permit No. Owner F I T T &e? C1 rmc/ n J' Type of Project: 1:1New ❑ Alter ❑ Addition Address G /� /'J PCiI /e S ElRepair ElConvert El Demo El Occupancy Pmt. /i/��/f/ City (, /V� Zip 92627Phone 63/ //6/ A.P. SUP. Dist Insp. Area Architect/ 2 / /q�-7n Designer �al/gt) No. /7V / ( Zone SPI. Pmt. No. l�✓laSLicense Address /0Q Gj A/ C©nG 01—d Setbacks P/L Front C/L St. Street Width ,� A City C M ZIP Phone�7j-� Yards Left Right ear - ave rol. a i9 Engineer License No. Park ng Spaces Required rov a overe Address Sir uct No. of No. of City —� Zip Phone Height Stories Family LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 am licensed under provisions of Chapter 9 Park FeesVas N Required o C.T. Fee Receipt Zoning Approved By: Date (commencing with Section 7000 of Division 3 of the Business and Professions Code, and my license is in full force and effect). License Class License Number Date Contractor Misc. Proposed Use of Structure Address City and Zip Phone CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Occ. Class Type Const. Code year USE/OCCUPANCY SIZE SO. FT. Lender's Name Lender's Address 1. OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law o he following reason: I, as owner of the property, or my employees with wages as their 2. sole compensation, will do the work, and the structure is not Xintended or offered for sale. I, as owner of the property, am exclusively contracting with 3 4. licensed contractors to construct the project. L� 1 am�� exempt under Sec. , B C for is rea // -340 Data//—/ Owner WORKERS' COMPE SATION DECLARATION Total Valuation Encroachment Permit Required ❑ Yes ❑ No I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Workers' Compensation Insurance, or a certified Grading Pmt. Required 1:1 Yes El No Grading Pmt. No. copy thereof. Policy No Company ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with Orange County, EMA. Rough Grading Approved by: Date Data Applicant CERTIFICATE OF EXEMPTION FROM WORKERT COMPENSATION INSURANCE (This section need not be completed if permit is for $100 or less). I certify that in the performance of the work for which this permit is PERMIT FEES issued, 1 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Structural $ Plan Check $ Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with suchElectrical provisions or this permit shall be deemed revoked. $ Special Invest. $ Plumbing $ 1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTH- ORIZE R RESENTATIVES OF THIS COUNTY TO ENTER UPON Mechanical $ Pre -Grade Inspection $ THE A OV /Illryfyyy�ttt1/����ENTIONjj QQ11 OPERTY FOR INSPECTION PUR- POSES /� _C7i� 6lJ T/ -/-3-- l�li� Signa ure of Applicant oent Date Pre -Grade Rec. No. $ Permit Issue $ �I TTE'�7 (�Gf 10 riot Applicant's/Agent's Name All spaces within this box must be com leted to process P Plan Check By: Issuance Approved: CMF 0335-46 (BU -28) rev. 6/80 CD C a b a a as a (With WL2) .)WNER Tartan Homes Inc. DATE 7-27-61 GENERAL CONTRACTOR Macco Oorooration VALUE $ 5,000.00 AP. No. LOT 37 TRACT 300 FIRE ZONE DESCRIPTION OF WORK Add FtPe.toRes. INSPECTIONS ftp DATE I GROUP 2 TYPE V ZONE R_1 Soil .,G Water - 17--�1-GJ SUBCONTRACTOR PERMITS ISSUED _Underground T -ground Gas — — DATE NUMBER t .ead Water and Gas Rough Heating Rough Plumbing -Z Miscellaneous Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating, Final Plumbing Fixtures Final Gas Test Construction Pole Underground Power Rough Wiring Tienches -Formsik"Steel k,A-L/ Floor System Steel Reinforce Chimney Re -Rod Bond Beam Sheathing Frame and Flshin La *ping, In Out Q-//- / r, brown coat / -�.o- oing Fixtures, Final /flW 0-26-6/ Electric Fixtures, Final Building, Final OCCUPANCY Form 210-5M-11-59 5-B P - - 11986 4i.;;.e. 14986 C;$STA MESA BUILDING -SAFETY DEPARTMENT P. O. BOX 317 . COSTA MESA. CALIFORNIA e I or. Applicant to Fill In Completely TYPE OR PRINTBUIL' RESS 1161 Gleneagle Terrace COSTA MESA. CALIFORNIA ER TARTAN,HOMES INC. MAIL FSR 7844-E• xosecrans ADDRESS 0251 F. 0 ence Ave. CONTRACTOR MACCO CORPORATION ADDRESS 3800 E. Coast Highway CITY Corona del"NarR California STALIC. NO. 98808 -SB -1-' . TEL - LIC. OR 3-4220 SIZE NO. OF 81068. OF LOT NOW ON LOT USE OF EXISTING BLDG. SETBACK LINE FROM 1 DESCRIPTION OF WORK 1 NO, OF WALL rLG RLUL-Iv6w JUL 27 1961 FINANCE DEPT. CITY OF COSTA MESA APPLICATION FOR PERMIT BUILDING For Office Use Only RECEIPT NO. I PEF z7-1,11 �D� 1951 FIRE ZONE f NO. OP ^ YBE OF NEW /r(JV -ON PLANS l/ BUILDINGro Eyil'f- �Da o... Lot 37. Tract 3h70 0 (CENTER LINE ST.). S FRONT 5v e —1 /7 © FT 1 Addition - 500 S. F. ,;,. 1 L71. d%JO�� I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLIGTION AND STATS THAT THE ABOVE IS CORRECT AND A TO COM- PLY WITH ALL CITY ORDINANCES AND STATE S GULATINO BUILDING CONSTRUCTION. SIGNATURE OF TARTAN HOTES j C. PERMB E �,ep AUTHORIZED AGENTNTT,/ THE AMOUNT SHOWN UNDER VALUATION IB FOR THE PURPOSE OF. ESTABLISHING A PERMIT FEE ONLY. VALUATION / 'L* PERMIT FEE $ ! �, �i $ 52000.00 PLAN CHECK $� �.. 21.00 OWNER DATE A')No. 115-632-0]LOT 37 TRACT 3470 FIRE ZONE VALUE$ 2.500.00 ECTIONS Si nature Date TYPE V GROUP I+-3 ZONE Rl SUBCONTRACTOR PE MITS ISS ED GAS Date Number $i nature WATER Plumbin ROUGH PLUMBING PROP. SWR. LINE ❑ HOUSE CON. SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND lJ POWER ❑ ROUGH WIRING Heatina and Vent. TRENCHES FORMS ❑ STEEL REINF. FLOOR SYSTEM plete f1S BOND BEAM STEEL REINFORCE SHEATHING FRAME AND FLASHING LATHING — IN OUT PLASTER, BROWN COAT ST—CTURAL. FINAL Electric I IG. VENT., REFRIG. AND A.C., FINAL PL_—GING, FINAL AND GAS TEST ELECTRIC, FINAL It M t2 2739 11/13/80 3_6_:50 TL COSTA MESA BUILDING -SAFETY DEPARTMENT APPL ATION FOR STRUCTURAL PERMIT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 I RE EI PERMIT N2 50994 For Applicant to Fill in Completely — Use Ink Only BUILDING / G/Enec� S A.P. NO. ADDRESS 10 I// OWNER OR (lI� ILOING DRESSUNIT TENANT MAILING t �j 60 file OR V SPACE NO. V ADDRESS ��/ TEL. /2/�// T�4 ;� LOT 2"� •�J BILK. CITY COS7-G 1041 .SC;? NO. FJ aJ (O 1 NEW DD ALTER REPAIR MOVING DEMOLISH CONSTRUCTION LENDER BRANCH OWNER ADDRESS //�%e�G� �'tRrNPi ALUE F^,O L111 T ARCHITECT _� EL. USE $ OR ENGINEER 0. "\ ADDRESS ZONE TYPE GROUP_" S S� CONTRACTOR BY DATE DATE /' /] � /a ' 0 's/ C.�hC 0 rd— STp /� ADDRESS /0f C NO` 73 �v CITY • /VI . 7 STATE APPROVED SETBACKS LIC. NO. LICVNO. X2733 SIZE NO. OF BLDGS. (FROMC LTREET) OF LOT NOW ON LOT / FONT (, FT. USE OF EXISTING BLDG. S ��C /7e c e Separate permits are required for L. SIDE FT. electric, plumbing and heating work. REAR FT. USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTIO DATE APPROVED APPCI.J N. I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under SO. FT. the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE NLV: am exempt from ons of the State of CAIRO is Business VALUATION PERMIT FEE $ Qp and Professions Cn 3 hapterc9� �',5r PLAN CHECK $ Signature I Permittee $ TAX $ O �� or O Authorized Agent Date ! / TOTAL PAID S,, SQ ' `'► X 147 42 COSTA MESA BUILDING -SAFETY DEPARTMENT -1 P.01 BOX 317 COSTA MESA. CALIFORNIA For Applicant to Fill In Completely TYPE OR PRINT COSTA MESA. CALIFORNIA FEE RECEIVED YJUN 281�o1 FINANCE DEPT. CITY OF COSTA MESA APPLICATION FOR PERMIT BUILDING For Office Use Only RECeiPT No. I Vr1i �cl? OWNER TARTAN. HOMES INC. YIBBUED MAIL ADDRESS 7844 E. Rosecrans RECHI SY DATE RECEIVED/ DATE Gi '��3�� JUN 2 8 19 Calif. NSE 6=1261 UILDNG CITY Paramount, ADDEISS E'g CT Cliff Olsten & TE i; 7NEER NbA 3-1221FIRE FADD�RESS9025k COSTA MESA. CALIFORNIA E. Florence Ave.,...Downe ZONE TYPE V GROUP CONTRACTOR Macco Corporation APPROVED BY " DATE ADDRESS 3800 E. Coast Highway ZONING CITYCalifornia, N ' / I NO. OF PUNS 'I/ I USH OP N BUILDING LIC. TATNO. 98808 -SB -1 � NO. OR 3-4220 LEGAL DESCRIPTION Lot 37 of Tract No 3470 SIZENO. OF BLDGB. OF LOT - 'Now ON LOT A. P. NO. USE OF YARDS EVES EXISTING BLDG APPROVED ALLOWED SETBACK LING PROM (CENTER LINE ST.) �� CENTER of SixeeT REAR YARD FRONT FT. IN. E YARD I LEFT I RIGHT R. SIDE FT. �� IN. DESCRIPTION OF WORK [REPAIR L. SIDE FT. IN. IX II I ]ADDITION I ALTERATION REAR FT. L aArL"y"���"LN. II MOVING I II DEMOLISH I APPROVED I DATE BUILDING NO. OF SIZE ROOMS STORIES l/ EXTERIOR WALL - ROOF I COVERING COVERING USE OF BUILDING AND WORK TO BE PERFORMED Re A t Gar G - 552 S.F. 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IB FOR THE AND STATS THAT THE ABOVE IB CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION BUILDING CONSTRUCTION. SIGNATURE OF� �Gsi+�j PERMIT FEE S 37.00 PERMITTE 17,959.00 PLAN CHECK S 18.50 55.50 AUTHORIZED AGE .4�Llf�EC� 70TAL FEE 5