HomeMy WebLinkAbout445 GLOUCESTER DR - Building PermitsAVGlicant to fill in all spaees exeeot those within heavY borGer lines ana si9n a11 apvropriate aeclarations.
CITY oF COS7A MESA CONSTRUCTION PERMIT
Project Address �Qlo i- c ar Cn_sta Mesa Ca 9�7 �_
Applicant's Mailing Address
Owner'sName ihe Prribrot (�Il �Phone—]_1Q-�a�
Address P.O. B�x PL164 I ag�na H� l.ls,_Ca-92�5n -
Arch(Eng. License No.
Address
Convactor'sName VdI1CP R ASCM1Rt'Pf Rmfim IR6b�e7�4-.���-����
Address (mailing) P-n- �x �0456 Costa Mos�, �� �fi�]
��
City l.icense No. �.19�3
LICENSED CONTRACTOR DECLARATION
I hereby afli�m tltat I am IicenSetl untle� provi5ion5 of Charter 9(wmmEnting
witM1 section ']000) of DivislOn 3 of the Business antl Protessions Cotle, antl
my license is in full (orce antl ei�ect.
License Class cense N ,��
Date ' ture'
WORKERS' COMPENSATION DECLARATION
� hereby aHirm that I have a certificate of consent to sel(-ins e or a certificate
Workers' Compensation Insurance, or a certifietl copy thereof (Sec[ion
�0, Lab. C.) �161030253U� Liberty NLtual Insura
olicy No. mpany
eCerHtietl copY �s he�eby fumishetl.
Certifietl copy is filetl with the city Builtling Dlvision.
Date� ��. Plicant
EXEMPTION FROM WORKERS' COMPEN O I �
(This section neetl not be campletetl if the permit is tor One huntlretl ($100) or
less).
I certi�y that in th¢ performante of tne work tor which tM1is perm�t is issuetl, I
snall not employ any person in any manner so as to become subject to the
Workers' Compensation Laws of Calitornia.
Dale Si9nature
NOTICE: If, af[er makin9 this tleUaration, you shoultl bewme subject to the
Workers' Comoensation provisions oi the Labor Cotle, you must forthwith
comply with such provi5iOn5 or this permit shall b¢ tl¢emetl revoketl.
CONSTRUCTION LENDING AGENCV
I nereby affirm that there is a construction lentling agency for the pertormance
of the work for which this permit is issuetl (Section 309� Civ. CJ
LPntler's Name
r� Lentler's Atltlress
V OWNER BUILDER DECLARATION
'. (� I hereby affi�m Lhat I am exempt from the Con[ractor's License Law for tne
( I following reason (Section ]031.5 Business antl Professional Cotle: Any city or
county wbicn requires a permit to construct, al[er, improve, tlemolish or repair
\ any SVuctu�e, p�ior to its issuance, also requires the applicant for Such pe�mit
'to file a signetl statement that he/she is licensetl Oursuant to the provisions o(
' the Contractor's License Law (Chapter 9(commenting with Section 7000) of
Division 3 ot the Business antl P�ote55ions Cotle) or that he/she is exempt
� �efrom antl the ba5i5 fo� the allegetl exemption. Any violation of $ection
1.5 by any applicant for a permit subjects the appli<ant to a civil
� .alty ot not more than five huntlretl tlollars ($500). .
L� I, as owner of the property or my employees with wages as cneir sole
compensation, will tlo the wo�k, antl the struchre is not intentled o��ofter¢tl
for sale (Section �044, Business an0 Professional Cotle: The Contractor's
License l�w tloes not apply to an owner of a p�operty wh0 builtls O� improve5
ther,qpn, antl-who tloes such wo�k himselt/herself or through his o� her own
' emploYees, prOvitletl that such improvement5 are nOt intentleG o� olferetl for
sale. If, however, the builtling ar Improvement is sold within one year o( com-
pletion, tne owner wi11 have the burtlen of proving he/she tlitl not builtl or im-
prove for Ihe puroose of sale). �
� I, as owner of the property, am exclusively contracting with licensed con-
[ractorsto mnsVuct the project (Section 7044, Business antl Profe55ions Cotle:
The eontractor's �icense law tloes not appry to an owner of�property who
builtls or imOroves thereon. antl who contracts to� such oroiects with a con-
tractor(sl license pursuan[ to ene ConVactor's license Law). 1 am aware that
proof of their Wo�ker'S Compensation insurance shoultl be provitletl to me.
❑ I am exempt untler Section B. & P. C. fo� this reason
Date
I h¢r¢by certify that I ha
inPormation is correct. I ac
antl state IawS �elating to
Sentatives of thi5 city to
inspectlon purpose
Signature ___��
Drivers' License or 55 �
Owner
ng cOns
K upan
.�_y............ q __..._. __..._. .,,.,,,..,.
_r✓ Z 1 L . , A.P.
S Main Buildi
TYPE OF CONSTRUCTION NEW 'AOD ALTERATION REPAI R E
❑ CONVERSION ❑ DEMOLISH ❑ OTHER� T Front
DESCRIPTION OF WORK/USE OF BLDG. I A Rear ,
I C Right
TVPEOFPERMIT GRADING FOUNDATION STRUCTURAL i K
❑ TENANT ❑ ELEGTRIGAL ❑ PLUMBING ❑ MECHANICAL S� L¢Ft
❑ �OTHER ' Ping. Ref. #
PROJECT DESCRIPTION 5Q. Fr. oCCUPANCv M Planning Notes:
CONSTRUCTIONTVPE VALUATION$ �%n?W
ZONE GRADINGCU.YDS. ACRES� ,
Remarks: �a�+
Bar Sink
Backflow Preventer
Backf�ow Irriga[ion
Clarifiers
Dishwasher �
Drinking Fountains
Floor �rains
Floor Sinks �
GasService Outlets
Interceptors
Kitchen Sink
Lavatories
Roof Drains
Reinspection Fea � $15
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑4100,000 BTU 0100,000BT
Reinspection Fee 15
_ _ -- --
0865-46, rev. /BB Whi[e - Building: Canary � Applicant; Pink - Accounting; Goltlenrotl - Asseszor
PLUMBING
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
laue Fee
Hood or Typel ❑
Canopy Typell ❑
Refrigeration System �
❑0.100,OOOBTU ❑100,000
System Repair/Alteretion
Fire Dampers
Registers
Issue Fee
FEES /automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Elec
Fan ,
F.A.U.
Fixtures
Device Boxes
Outlets
$WitCh¢5
Garbage Disposal
Generator �0-5 KW �
Fee
Zone
Accessory Building:
Parking Req./Provided
ELECTRICAL '
� Transformer ❑ 15-50 KW
❑ SO+KW
5-15 KW
$15
Meter ❑up to 100 amps
Meter ❑over100amps
$ub Panel
Motors�61 HP�1'Fi-8
Inc.Solar �9-15 HP �16-15+
Microwave - r
Pole Light �
Range �
$Il]fl
Standing Sections � '
Tresh Compactor
Issue Fee �
$ 3 DEVELOPMENTSERVICESREQUIREMENTS:
Zoning Approved By
FEES .' Building Approved By �
�i' Appliwtion Issued By
$ 3
SUMMARY OF FEES �i
BUILDING PERMIT $ �Q�r= SMIP _ .
PIAN CHECK $ PERMIT. "'
PLUMBING $ ISSUANCE
PLAN CHECK 25% $ ENERGV P.C.
ELECTRICAL $ GRADING
PLANCHECK 50°k $ MICROFILM
MECHANICAL $ TOTAL FEE
PLAN CHECK 25% $
O
N
I
N
G
R
E
Q
M
T
S.
FEES
$ 3
ro
$ �--
Ui �CO3?727-OU937728 TCaT
GATE: 07J13/89 T1CIE: 4�:'?Q
`.� . - `�,-_. . .. - � .,,, �
CONSTRUCTION AND PLANNING POOI 'PA
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 - �� -1
6. Electrical UFER Grnd. ,� 57. APPROVAL TO COVER-GUNITE ^
7. Footings i,-i� 58. Electrical Conduit-Undrgrnd. �
8. Foundation ..,.y� 59. Gas Pipe, O Undrgrnd., Test . Z.�
9. Water Pipe-Undrgrnd. L 60. Backwash Lines, P-Trap, � Undrgrnd. L'S
10. Structural Floor System � 61. APPROVAL TO DECK
11..Property Sewer Line & House Conrie�tion 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 O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underqround Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ 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 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
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 pomestic-Final
42. Backflow Preventer � ✓"
✓'
43. Backflow Irrigation "
n
44. LandscapelrrigationSystem �� 1�
45. Sound Attenuation �
46. Handicap Regulations _
47. FINAL STRUCTURE & BUILDING YJ! 5�,��� �_ �/
48. Special Requirements Completed
49. Electric Release to Edison � ' �-'
i
50. Gas Release to Southem California Gas Co . ��' �
51. CERTIFICATE OF OCCUPANCY � �
i .' .
No. Date �� �
1
QtF �UBT'���'i LGT'"� Z�' qoc�icant to fiii in all spaees except thase within heavy EorEer lines anG sign all apP�opriate Geclaratians.
PE IT NO � TRACT NO LOT NO UNIT NO
CITY oF COSTA MESA C/O�N TRUCTION PERMIT
" Proje� Address � � V C'e
, Applicant's Mailing Address 3�
Owner's Name Phone �
Address
Arch/Eng. License No.'
Address
Contractor's Nam Phone
Address (m� I'��1 �-7 O �
City'LicensP No -.�, D /c�_S . .
LICENSED CONTRACTOR OECLARATION � -
I hereby aftirm [hat I am licensetl untler provisions ot Charter 9(commencing
with sec[ion ]000) of Division 3 of the Business antl Protesslons Cotle, antl
my license is in (ull 9f r� tl eftect. �-p
^ LicenSe I n/� r7-�y-��- a�'�' e 0 �, n�
^J Date ���� �'� t (�(�
�
WORKERS'COMPENSATION DECLARATION �
l i hereby aftirm that I have a certificate�of mnsenf to self-insure or a tertiticate
� ' Workers' Gompensation ,Insurance, o� a certi(ietl copy thereoi (Sectlon
� 00, Lab.. /7. '` - . �._{� / _ ��
177�YLo
-olicY No. ��% `��Y �� GomPanY � �""�v_y__L
�ertifietl copy is hereby furnishetl.
er Ifi co flletl with the city B}� n
oate.�� � � ApplicantT ���� .
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Thissection neetl n0[ be completed if the permit is tor one huntlretl ($300) or
less).
I certity Ihat in the pe�fo�mance ot the wo�k fo� which this pe�mit is Issuetl I
shall noi employ any person in any manner so as to become subject to t�e
workers' Compensation Laws of Calitomia. �
Date Si9nature
NOTICE: If, after making this tleclaration, you snoultl become subject to the
Workerz' Compensation provisions of Ihe Labor Cotle, you must (orlhwith
comply with such provlslons or tnis permit shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV ' '
I hereDy afflrm tha[ Nere is a construction lentling aqenty for the performance
of the work for wnich this permit is issuetl (SectiOn 3097 Civ. C.)
Lender's Name - '
Lentler's AtltlreSs �
OWNER BUILDER DECLARATION
I hereby affirm lhat I am exempt (rom the Gontractor's License Law for the
lollowin9 reason (Seclion �031.5 Business anC Professional Cotle: Any city or
county which requires a permit to construct, alter, improve, tlemolish or repair
any structure, prior to itz issuance, also requires the applicant for such permit
'refrom antl the basis for the allegetl exemption. Any violatlon ot Section
'1'.5 by any applicant tor a permit subjects the applicant to a civil
.alty of not more tban five huntlretl tlollars ($500). --
J I, as owner of the oroperty or my employees with wages as their sole
compensation, will tlo the work, antl the structure is not intentletl or.offeretl
for sale (Section ]044, Business antl Professional Cotle: The Contractor'S
License Law tloes not apply to an owner of a property who builtls or improves
Ihe�eon, antl who tloe5 Such work himselt/herself or through his or h2r own.
employees, provitletl that sucn improvements are not intendetl or offeretl for
sal¢. �It,'nowever, the building or improvement is soltl within one year of com-
pletion, the owner will have the burtlen of p�oving h¢/She tlitl not builtl or im-
prova forthe purpose oisale).
❑ 1, as owner of the property, xm exdusivery contracting with licensed con-
tractors to construct tne project (Section ]044, Business antl Protessions Cotle:
The ContractoCs License Law tloes not appry to an owner of property who
builtls or imoroves [hereon. antl who contracts for such oroiects with a r.on-
tractor(sl license pursuan[ ro�ne Contractor's �icense Law�. I am aware tbax
proof o1 thei� Worker'S Compensation in5urance shoultl be provltle0 to me.
❑ 1 am exemp[ untler Section B. & G. C. for fhis reason
Date Owner
I hereby certi(y that I have reaE this appliwtion antl stare that the above
information is mrrect. I agree to compry with all city antl county ortlinances
antl sta[e laws relating to builtling consfruction, antl hereby authorize repre-
Signature (,�►//
Orivers' License or 55 '�
, 0865-a6, rev. 5/88
Date�
� ' � : " A.P. #
S Main Building:
TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR E
❑ CONVERSION ❑ DEMOLISH ❑ OTHER ' �' ; FrOnt
DESCRIPTION OF WORK/USE'OF BLDG. A Rear
TVPE OF PERMIT ❑ GRADING�FOUNDATION STRUCTURAL . I C Right
K Left
❑ TENANT ❑ ELECTRICAL PLUMBING O MECHANICAL $'
❑ �oTHER Ping. Ref. #
PROJECT DESCRIPTION SQ. F7. OCCUPANCV Planning Notes:
CONSTRUCTIONTVPE ' VALUATION$
ZONE GRADINGCU.VDS. AC13E5 '
Remarks:
Sink
Preventer
Irrigation
Dishwasher
Drinking Fountains
Ploor Drains
Floor Sinks
Gas Service Outlets
Interceptors .
Kitchen Sink
lavatories �
Roof Dreins
Reinspec[ion Fee � $15
ooue�
Duct-UnderGround
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Blt. iC80 #
Heating System & Ducting
❑ P7 00,000 BTU � 100,000 BTI
Feinspection Fee � $15
White - Builtling; Canary - ApPlicanq Pink - Accounting; Goltlenrotl - Assessor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping '" '— .
Solar Tank -
Swimming Pool w/Spa
Urinal
Water Closet .
Water Heater _
Water Service
Auto-Wash � �
Fee
Hood or Typel ❑
Canopy Typell ❑
Refrigeretion System
i
❑o-i oo,000 eTu ❑ � oo,000
System Pepair/Alteration
Fire Dampers
Regis.ers �
laue Fee
FEES P�utomatic Washer
Construction PoleSub.
Cooking Unit
Dishwasher ��
Dryers ❑Gas;;�Electric
Fan j'
F.A.U. . .
Fix[ures
Device Boxes '�.'
Outlets
Switches
Garbage Disposal
. Generator �0-5 KW �5-15 KW
$ 3
FEES
$ 3
2ona
Accessory Building:
Parking
IICAL
Trensformer ❑ 15-50 KW
❑ 50+KW
Meter ❑up to 100amps
Meter ❑over100amps
Sub Panel
Motors 067 HP �1 h- 8
InaSolar �9-75 HP �16-15+
Microwave
Pole Li9ht
Range
Sign
Standing Sections
Trash Compactor
. Reinspection Fee $15 luue Fee
DEVELOPMENT SERVICES REQUIREMENTS:
2oning Approved By
6uilding Approved By
�' Application Issuad By � n .
� SUMMARV OF FEI
FEES
$ 3
N
�..
N
G
R
E
�
M
T
S.
BUILDING PERMIT $ SMIP $
PLAN CHECK $ PERMIT
' PLUMBING $ �pl%ISSUANCE $ �
�� PLAN CHECK 25% $ ENERGY P.C. $
ELECTRICAL $ GRADING $
PLANCHECK 50°.6 $ MICROFILM $
MECHANICAL $ TOTAL FEE $ �
PLAN CHECK 25% $
G2 00035YS4-QpC?v454 T�r7'H' `J.jt1
DATE: Q3108/t;j TItiE: sp:15
� . _, . _.. �
G � ;�
,
� CONSTRUCTION AND PLANNING ,' POO' �PA , �
ljPPROVALS Permit # D'at' �Inspector p�ppROVALS Permit # Date Inspector
v 1. Temporary Electrical Service or Pole � 52. Pool & Equipment Location
� ��
2. Soil Pipe-Undrgrnd. .% ✓,�� � 53. Steel Reinforcement . ��%
�
-3.. Electiical Conduii Utility-Undrgrnd. � 54. Forms '���
4., Electiical Conduit-U�drgmd. -T % 55. Electrical Bonding� . ��
5. Steel�Reinforcement� � � 56. Rough Plumbing & Pressure Test �x. ,
.,
�6..�ElectricalUFER�Gind:� � 57. APPROVALTO�COVER-GUNITE �-%' .
.7..Footings �.i !'�. � 58. ElectricalConduit-Undrgmd. ��%''�
8. �Foundation .i`1;� "� �� 59. Gas Pipe, O Undrgmd., Test � !i�'
. 9., Water Pipe-Und;"grnd. .i'n �� 60. Backwash Lines, P-Trap, O Undrgmd. - ��''
�.
10:'Structural Floor System !� �• P 61. APPROVALTO DECK �
.11 ., Property Sewer Line & House Gonnection ,.> >^ 62. Backwash & Receptor-Final �.
12.' Sewe� Cap ^��,i' „!'I ,�+� 63. Heater & Vent-Final .
13.JRoof Drains '� � �, ��, -/ . 64. Plumbing SYstem : Final ' � y �
14. Rough Plumbing� S �i � 65. Electrica6Final , � ✓
15. Rough Electrical-Conduit 66. Solar System-Final
lt& Rough Electric Wiring . 67. Fencing & Access Approval
i
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
t.,
i18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT: REQUIREMENT
2d. Rough Factory Fireplace , APPROVALS Permit # �
21. DuCts, in Structure , � 70. Underground Hydro
22. Ducts, Ventilating 77. Product Piping O Gas ❑ Oil
23. Gas Pipe-Ro�gh & Test 72. Underground Flush . �
24. Roof Frartiing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing _ ,� 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat �` � 75.'Dry Chemical
27: Frameand Flashing " � � ' . - ' - � 76. DryStandpipe � � `�'�``�`��
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-Flnal 80. FOOD CERTIFICATE ISSUED
33. Final Electric � Notes: j/i/�q G��T �.(Zp• L,��/% �
34. Final Heating & Air Conditioning � �
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace � �
38. Final Plumbing �`
39. Water Service-Final �
40. Gas Service-Final :'1 l;�
7. n+
41. Solar pomesticFinal; ."7 �
,'� �42. Backflow Preventer� 1' • ,
�4'
43. Backflow Irrigation;,� � �-� + .
C� w•.
44. ,Landscape Irrigation System � � V - �
�"
45. Sound Attenuation � v "
46. Handicap Regulami`ons a�
47. FINALSTRUCTURE&;BUILDING � .
48. Special Requirements Completed •
49. Electric Release to Edison n
50. Gas Release to Southern California Gas Co �,.= " � �:
51. CERTIFICATE OF OCCUPANCY j �
No. Date A •
;%
�. ' 21 �J7. 8
COSTA MESA BUILDING-SAFEfY DEPARTMENT
P.O.BOX 21] COIITA MEBA�CALIFORNIA
For ApplicaN fo Fill In Completely
TYPE OR PRINT
ADDRESS �i�— ��U�E�P �j�//�F
- COSTA MESA, CpLIFORNIA
OWNER lJa. e Series InCc •�
wo"' RE88 504 No. NeWporY Blvd.
,,,.�. Newport Beach, Calif. ;�'-•646-93
FEE RECEIVED
ROV 2 7 .1989
FINANCE DEPT.
CITY OF COSTA MESA
APPLICATION POR PERMIT
BUILDING
For Office Use Only
P6CEIPT NO. I � �gF
ZONING
�¢ Ho. or uee ov NcvD�-i.y
� / PL6N6 � BWLDIqO�� `(�
� 1� �
'-eOA1' 24 T 5212
� DBSCRIPTION Lot ract
ADDRE88 504 N Ne ort Blvd
�,TY Newport Beacfi, Califr w.P.No. •Ff
STATE 221233 *��. 646-9341 30TT0 H�IDB B REAR P
LIC. NO. NO. -
oF�or 18.83 x 50.08 OWeN r � eaves
SIZE No. o� eLooe. ALLOWED
YARD8APPROVED
USEOF nOne ' MAINBUILDINR
EXISTING BLO6. •
�. b (FROMGLSfREET)
BETBACK LIN6 PRO� �(r PRONT FT.
CENTER OF YTRHiT � RHAR YARD
I!� I ll o a�nv O cT
DESCRIPTION QF WORK
1 BUILDIN6 1235
C�IZE
d USfi OF
Ok ^ VAR. SC
'M$ 4 STOR169 L C. U. P.
;°�e,,,,, ceclar shake Bv�'RO'
�1 HEREBY ACKNOWLEO08 TXAT I,XAVg, REAO TH18 �PPLICATION
AN� BTATB TNAT TH6 ABOVB IH CORRHCT 1NO AONEB TO COM.
PLY WITH ALL CITY ORDINANC68 ANq 9TAT6 LAW➢ R80U{ATINY
BU�LOINO CONBTRIlGT10N.
' AUTHORIZEDA6ENT�`��/�
SHALL BE LE35 THAN
�
�
�
YARDSAPPROVED
:CESSORY BUILDIN6
DATE
�
TNE �MOUNT 9XOWN UNGER VALUATION �3 FOq THH F
PURP09H OP iBTABLI6MIN0 A PERMIT FEH ONLY. Q
VALUATION ^� �]^/ ^� m
�11� 423. / S PERMIT FEE $ J/. 2/ j
0
$ A C C oo O
TOTALFEE $ ��• �� n
Z"'
w
�
LL1
�
..7
a
�I.�
a
�
a
v
a
�
�
O
L3.
Q
,
�