HomeMy WebLinkAbout3029 GRANT AVE - Building PermitsPq0.1ECT pOUHESS: , 3 O Z 9 GRANT AV
OWNEfl'SNAME: MILLARD MARTIN H
aoosess: 3029 GR�;NT AVE
COSTA MESA,CA
�.
ABCNIENGMEEB:
. � AUOBESS: � .
92fi26
flEC.NO.:
UNIT:
UNIT:
�
PE"mmEE` NiARTIN-'MII,LARD � ( 714 ) 650-1600
aooaess: 3029 GRANT AV
COSTA MESA CA 92626
LICENSEU LONTBACTOH DELLRBATION: I hereby a��irm Iha� I am Iicen5e0 unUer pmvisions o� Chapier 9(commencing wi�h Seciion
7000) o� Oivision 3 0l the Business an0 Prolessions Caae. ana my license is in lull brce an0 effec�.
CITY LIC.: STpTE UC.: ClASS: .
Oate: Signa�ure: .
WOHNEBS' COMPENSATION OECLANpTION: I here�y aftirm ihat I have a cenificate ot consent to selbinsure or a cenilicate oi Workers' �
Compensation Insurance. or a ce�ified copY Ihereol,(Section 3800, Lab. C�.
POLICY NO.: EXP. UATE:
COMPANY: . �
� Cenilietl caDY is hereby furnishetl. ❑ Certifie0 copy is fileE with the city Builtling Uivision.
�
Oa�e: APPlican�:
E%EMPTIONFPOMWOBREBS'COMPENSATIONOECIAPATION: (Thi sectionneeAno ecaln etea� lh permAis�/onehunOretl�$1W�arless�.
I t¢htly �hai in Ihe peAormance ol the work �or which this per 5 issu 0. I 5 al n I4n by rson in ry manner so as �o hecome
subject lo Ihe Workers' Compensa�ion laws o� CaliPomia. i
' Daie� O' `L Signature: �
�NO710E: If, after making his Ueclara�ion, you shoWd �e e suble � ihe Workers Compensati provisions ot ihe Labor
Code. you must totlhwith comply with such pmvisions or Ihis permit shall �e OeemeO revoketl.
CONSTBUC710N LENOING'AGENCV: –1 hereby ailirmihatihere is a cons�mctian.lenJing agency.far.ihe.petlormance oi ihe work lor
w�ictl �his permit is issueU (Sec�ion 3097, Civ. C). , � �
� IENDEN: � � �
aooeess: - ,' - . -
OWNEfl BIIILOEP DECIAPRTION: I here6y aHirm Ihat I am exempl imm Ihe Cantrac�ors' Staie License Law �or Ihe�lollowinp reason
(Section 7�31.5 Business an0 Pwiessional Code: Any city of coun�y which requires a permi� to cons�mct, alter, imprave, Oemolish, or
revair any 9mdure. prior lo its issuance, also reQuires ihe applicant for such permil b file a signeA statement that ne/she is licensee
pursuam io �he pmvisions ol the Conlracto�s' State License Law (ChaD�e� 9(�ommencing wilh Section 7qp) of Oivision 3 ai ihe Business .
antl Pmfessions Code) ar �ha� helshe is evemp� Iherefmm antl.��e Gasis lor Ihe allegetl exempiian. Any viola�ion ol Section 7031.5 Dy
any apDlicant for a permit sublecis ihe applicant to a civil penalry of not more ihan five hundred Oollars (5500).
�I. as owner of Ihe pmpetly or my employees wi�h wages as [hei� sole compen5a�ion, will Oo Ihe wark, antl �he
❑ s�mc�ure is no� inlentletl or o��eretl �or sale (Section 704a, Busine55 and Pmlessional Cotle: The Comractors' S�a�e License Law
tloes not apply Io an owner of a pmpeny who builtls ar impmves Ihereon, and who tloes such woB �imsel�/herself or IhmuAh
his or �er awn employees, pmvitled thal such improvemenis are noi inten0etl or offere0 for sale. If, however�he �uilAinA or
impmvemenl is sold within one year of completion, �he owner will have the �urden ol pmving he/she tlid no� builU or imD�ove
for tne purvose af sale�. �
I. as owner o� �he pmpetly, am evclusively conUac�ing with licensed coniraciors �o cons�mcl �he pmlect (Seclion 7044, Busine5s
❑ antl Pm�essions CoOe: The Conlractars' State I.icense Law tloes not apply to an owner of property who �uiles or impmves �hereon
and who coniracis for such pmjects wilh a contracmr(s�license pursuantto ihe Cantracmrs' State License Law�.l am aware -
Ihai pmo� o� Iheir Worker's Campensaiion insurance shoultl Ue providetl to me. . - �
[� � am exempi unaer Section� B P�T O S�} B. 8 P. G �
m� mis reason. ALL WORIC HY OWNER �
Oate'. �n—��� % _ Ownec ^
I tlo hereby cenity ��at I am aware of antl untlersiand Ihe reQuiremenls of Calitomia,Heal�� a Safely Code Sections 25505, 25533, an0
25534 and iha� lor anylu�ure building acupanlwillNnll nol (circle one� nee0to camply wilh SaiU s�a�e catles and Ihe requiremen�s�or a
permit lor consimction or moadicatian Irom Ihe Fir Oualily Managemeni Oisirici. Fesitleniial cons�Nclion applications are eKemOt <<om
Ihese provisians. � ' .
Dale � FpplitanL .
I hereby ceriifyi�at I have reatl�his applicalion anA Sla�e
ortlinances antl Slale laws relating Io bwltling constmclion �
pmperly lor inSDe^ciion purposes.
Oate: ��� / �'� I � Signamre:
Oriver's License or Social Securily k� � � �
is corr@ct. I ree to com wilh all ciry antl county'
Nd�+e{ oi t�,Qry to eni pon the above�men�ionetl
164L06 White—Builtlinq; Green—Gotle En�orcemenP. Canary—Aool¢anf. Pink—Revenue: Goltlenrod—Assa.ssar '
.. i CITY OF,COSTA MESA - RUILDING PEkN,IT,; PERM'NO; B 05967�
PERMIT NO;.B 059677 PLAN CHECK NO; N GOVT; N SUPP; N.
CONSTRUCTZON TYPE: 5-N;� PERMiT TYPE; STR PURPOSE; REP
;
JOB DESCRIPTZON ; REROOF SFD W/ATT GARAGE ('ASPH, SHINGLES) SQ FT; 1,200
Ci,AIM, VALUE; 1,200,00 CALC-VALUE: 1,200,00 GROUP OCC; R-3 •/M-1 ,�
COMMENTS• SMOKE DETECTORS RE�iJIRED PER 1991 0�� g�p�E DET�ECTOR ,
�r*�t�r�x�***�***�,�x�*�r*+�x�xx�xx� *��*�*x��r�*��*�**�****��x**xx,, � i� i �,i,x
Z O N Z N.GS ERTEB�AUCIxRSE M E N T S R EQUIR E D
----------- MAIN HUILDZNG ----- ---- --------- ACCESSORY HUILDING ---------
FRNT; . FT IN REAR; FT IN FRNT; FT IN REAR; FT IN
LEFT: FT' IN RGHT; FT IN LEFT; FT 3N�RGHT; FT. IN
PARRING REQ; PROV: PAACEL: 1911.3308 ZNE; REF NO;
PLANNING NOTES> �
� . , �
*i�-ic��-*-z�**ifit�****itic�*****�E*it�**i�i�** it**i[�it**�E�t�*iE*i���Fit���ic�*itit*x�x�*�x��i��*i���x��-x�rt**i��<k�it�ikit�x� x��t��c�it�
U E V E L O P M E N T S E R V Z C E S R E Q U I R E M E N/''r�`T�S
ZONING APPROVED BY DATE � '�
BUILDING APF�ROVED BY' i ' � DATE'; � 1_
% �� (! G •
APPLICATZON ZSSUED HY• 'DATE; �!0 23 /2
1Ei6-IFifiF�lfiF7FiE�fif-lE1FiE1F�1PiEiElfiElfiFit3F��t�t3F�iFtlxxxr, x� i�ititxi trttr � 7F�Fzi�ir3fiFititififik',FiF�IE9fjFiElf �r,,fitit fr�cR�xit-It
rtir*itxiE�E�*****�fu****x**iE�*atitx�t�*��tiE�*��itft��xkx�i ,�x��it*iE��tiEu���-*x*xiE'k��.�isx�•w�*it�F*x**�e
LEGALI'LATION:N F E,E S U M M A R Y S'tRUCTURAL"� SBGMENT:Y
� . ✓� 1
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMiP/kES � GRADING
PfiRMI1 24.00 � . � ,50
.SMIP/NON-RES
PLAN: ;
ISSUE FEE � {�� �
BUILDING-DiV-:> PERMIT ISSUE PLAN-CHECK TOT'AL 'PAID=y DUE
TOTALS----> 29.50 . 0,00 0,00 2,9,50 29,SO�y;.� ,00 .
REVENUE D3VISION TOTALS-->. COLLECTED: 29.50 �VER/SHORT• f� 00 :
BLD29PM�T� PLUMBING ELECTRIC'MECHANIC FZRE SMIP/TO'OT GRADING�LAN-CHE�K
;.9
. : ' � .�"� ' .
f
ic iE �E iE 1E iE iE �E iE iFiF iE iE if iF iE ik iE �E if 1E iE fE iF iF iE �%iE if iE i4 iF iE iE if 3E iE iFiF-1(-iE iE iE JE !E 3E iF if fE iFlf :F i6 # if 1E M� �Jh 3E 3f fE if �1f�iE iC 3E iE �IE iE fF 3E # iEiF iE if !F iF iF
I N D I V I D U A L �F E E B R E A K D O W iy
�,. :
TYPE QTY D E S C R,I, P T I O. N UNIT COST �;3'OTAL COST
✓
SFR 1200 REROOF BY VALUE RESIDENTIAL NOZONE 1.00 �'l 1,,200,00
' _1 END OF FEES , '
f'
, OZ t341:57uQ-f.,{)22n7$5 �':�'!-
DATE: i0/?3/r2 TIt�E: �:r,saL'
_?.�.
f � i
� CON:TRUCT:�N AND RLANNING�' _� � '� � � � � , ,,. . POOL PA � _ ' _ � ��y -
Date . 'Jnspector � � � � �, Date ' .inspector,
T APPROVALS Permit;# �" - = - � = APPROVALS Permit # �
� . �_ . . s _ - - : Y ` - - - � �'. "/�
:. .1r�Temporary•Electricai Service or Pole � :; 1 . ,� = �52.'�Pool & Equipmenf Loca[ion' ' 1 ( � , " ;
, 2.` Soil Pipe�Undrgrnd. �_ • � � s�, � ' . .� � �53.,Steeb Reinforcement � � - . �i � _ , . � / .-' ti '.
V
3. Electrical Conduit Utility-Undrgcnd. � % ' 54.'�Forms` . - , � � � � "
r'. Y ''
4.- Electrical ConduibUndrgmd. - - ` `1T- - - 55. � Electrical Bonding- � %7 � "1
r5..Steel Reinforeement. . • � "_ . -' � 56. .Rough=Plumbing & Pre'ssure=Test ;
-.,6. Electrical UFER Grnd: �� . _. " - 57.�APPROVAL 70lCOVER�GUN6TE - „ - M :
,7. Footinqs -- ., _ ' . - 58. -Electiical Conduit�Undrgrhd. � . - � � -�
- 1
' B.��Foundation ` � ��' ' , ,
. 'y�; i - - 59. Gas�Pipe, O:Undrgmd�.; Test �.� �j `
9S Water Pipe-Ur�dr9rnd.: ^ ' � :v� � 60. Backwath �ines,�P�Trap; O Undrgrnd, f��� �
70. Structurel Ploor Sysiem• ' _ ' ".��: ;✓ 67. APPROVAL�TO��ECK� .._,__.• � � - +� i I
it. Property Sewer Line &`Rouse ConnecTion - - _. �,•'" . 62.;,Backwash & �Receptor�Final- � � _ E
_
12. Sewer CaP . ' s. � .. ; � �. � . , � ? . _ -'��"'Y
. • r� ^� �,-` 63.� Heater & Vent-F.inal � :� � � ,,'
13. Roof Drains - � ' ' ' � '
.' �- � ,.; . 64.-Pium6in9 SYstem`• Final' _ l� � -.•fy9 `
14. Rough Plumb��9 • � - •�'•-"� � 65. Electrical�Final ;; „ = ' � p �-
15. Rough Electrical-Conduit ' �. ' 66. Solar System-Final . _.,; . .{� � n
-'16. Rough Electric WiringL ,- . � � 67.,-Pencing & Acce"srApproval ':; -
77. Rough Wiring Sign . •- . i 5" �. 68.,�APPROVED�FOR�PLASTERMG ]�. - ' k
18. Rough Electricai�T Ba'r,Ceiling : - � `'� 69.'��ROOL'/SPA'SYSTEMS fINA� � - . � -
t9.�Rough Heatirfg & Air Conditio�ing �- ' ' ' "' ' " FIRE�DEPT. REQUfREM1AENT' - ' `
. . .� �r� .. - �
20. Rough Factory Fireplace � � • � � - • �i r . APPROVALS= �-�Permit # .
� , ,
21. Ducts; in Structure � \, ,. . _ , 70. Underground�Hvdro • � .
22.�Ducts, Ventil9ting � � 71. Product Piping O�Gas OOfI
.
23.'Gas�Pipe;Rou9h&'T,est � '� . � �. , 72. Underground�Flush :. . .i
24. Roof�Framing� '_ � � � - ' " ' 73. _Undergmd. Storage Tank O Gas ❑ OiI'
25. RoofSheathing '. � �� � . �.; '' j4.�-Overhead Hydro � � � � �
26. T�Bar Ceiling (Structuraq & Monocoat • , ' 75. �Dry Chemical - - , '
27. Frame and Flashing . 76. Dry Stand{�ipe �'" -
�28. Lattiing & Siding � . � . . . • �• •� •i - ' 77, -�FIXED SYSTEM-FINAL � '
29. Insulation '. :: •. . ,," .. I � i. 78. FIRE PREV. FINAL - ,
30. Drywall Nailing - � � �� � J,h��� HEALTH DEPT.-REQUIREMENT
;31. Plaster Brown Coat ' � � t�" _ .79. FINAI INSPECTION ` -- ' ,
•32.�Electrical�Power Meter�Final �. � ���.� 80. FOOD CERTIFICATE ISSUED
33._Finai Electric� � " ' �'��! _ Notes: � � -, -
34.,f.inal�Heatin9�&AirConditioning.' ;1. �' ( `� � , �� �
.'
� 35. Final Gas PiPe-Test . . - , . ' - . �
r
36. Hoodor�CanOPY, • . � �• � � �I -' .. ,c = �
,s'.:
'37.�Final Factory Fireplace ' '` � ' ., jf� � ' -
i�,
38. Final Plumhin9 � ; - �. ' I �t r ' .
39. Water Service�Final - I I u � -
40. Gas Service-Flnal - _ . � ' I i� • , _ .
41. Solar OomesticFinal - - ` `
42. Backflow Pre�enter - . I I .. ,
. A3. Backfiow Irrigation�'� - � . � �
44� Landscape Irrigation System � � - � _
�45� Sound�Attenuation`,, �.3:� - � �
46. Handicap Regulations � � '. � � , -��� ��C�
47: FINA�STRUCTU.RE&.8'"'1°11LDING � 3071 � 'i . ���
i ��• _._� (�i
48�. FINAI PLANNING"' �. I I� i I
� .. - �
.49�. Electric Release to�Edison.j � ( t�� � �
50� Gas Release to Sout�m California Gas Co � i+r`�� . � �
� 51'. CERTIFICA7E OF:OCCUPANCY t
No. � Date
OWNER WYRICK. Clifforcl R.
DATE 10-1-6Z
JOB ADDR�SS 3029 GTBnt St. ' BUILDING PERMIT NO. 1Y`J71
GENERAL CONTRACTOR OFmer-Bldr. VALUE $ �7�5� -
AP No1�i1-133-Oa LOT TRACT FIR� ZONE DESCRIPTION OF WORK • •
INSPECTIONS
7
G�
OCCUPANCY
Signature � DATE � GROUP J TYPE I=j ZONE $-1
SUBCONTRACTOR
,.
� �� - 179 I�
r
COSTA.MESA BUILDING-SAFETY DEPARTMENT
P. OlEBOX 91] COBTA�MEBA. CALIFORNIA
For Applicanf fo Fill In Completely
- - � .' TYPE OR PRINT
BUILOING _ '� ' .y�
ADDRESS �. `J � / ��S
_ COSTA MESA. CALIFORNIA '
TEL..
GITY Cl. S CL. NO.�`
ARCHITECT - , TEL. �_.
OR ^"GINEER NO.
,v7"` ST
BTATE . � TEL. ^
LIC. NO: NO.
SIZE V NO. OF �BLDGe.
OF LOT �. O �S /� p � I NOW ON LOT
USE OF . ,-e .. _ .� ._ . ._ � _
LIN¢ FNOM
ILEFT p� ,/ I RIGHT O�
DESCRIP410P1 OF WORK
. ��� ��������.
. " �,��iYnIV�� ��9�. '
G1TY Of 'C{-{��A �1�9s
� APPUCATION FOR PERMIT
BUILDING � .
.For Office Use Only
' . neceirr NO. P���� f
, �I%CD BY I. OATE R6CHIVED]/ '�/ DATE 19SUlD
iCl !�^/�� 1 ..
BUILDING
AODRES6
. � COSTA MESA. CALIFORNIA �
ar • �i owre
ZONING
, 8' I NO. OFA �I U8H OF N
PLAN6 �� � BOILOINO
�eaw�
YARDS EVES
APPROVED ALLO
/! (CeNT6R LIN! 8TJ �.���
. IOR'WALL ROOF -' '
ING COVERING
OF ILDING AND WORK TO BE PERFORMED
%�� G G O
� 6 ii ��o ��
� _/ . ,
7� s �6�%/iq:
I X[PBBY ACKNOWL6DOH TH T 1 HAVE READ'TXIB APPLIGTION
AND BTATE THAT TME ABOV¢ IB CORR6CT AND A6RE6 TO COM-
PLY�WITH ALL CITY ORDINANCEB AND.6'�ATB IaW6 R80UTATING
BUILDIN6 CONBTRUCf10N..�� ' ' � �
SIGNATURE OF � "G _„�y,���L '
PERMITTE , � �
AUTHORIZED AGENT ' I
THE AMOUNT BHOWN UNOEP VALUATION I9 POR TH8
PURP09E OF,- EBTABLI9HING A PERMIT FEE ONLY.
VALUATION - ` ' � G�
�(� . PERMIT FEE $ �'
S �/a ,� PLAN CHECK $
/ TOTAL FEE $ � �
OWNER �zCK JupE DATE
�nn �nneccc ..nnn ..___� '______" ' , � en�� nu
SUBCONTRACTOR
ROUGX PLUMBING ' � �
BROPf SWR. LINE n HOUSE.CON. _ !
� MISCELL�NEOUS
POUGN MEATING �ND �IR
TEMPORARV SEPVICE OR
UNOERGROUND
ROUGN WIRING
fR�ME ANO FLAS
LATHING - IN
PLASTE0.. BROWN
1 VG, VENT.,
P...,BING, FINAI
EIECTRIC. FINAI
BWl01NG, FIN4L
' '7 � . � ' PA70 . . . � .
,R , . T ��4� ' AUG —4-77cnsa00 887� ****36.50
COSTA MESA' BUILDINGSAFETY DEPARTMENT - � . . _ � - -
� P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 . � ' • , � � � �� .
� � APP � N FOR STRUCTURAL PERMIT�- '
For Applican[ to Fdl in Completely — Use Ink Only .
REC DATE RECEIVED E U .
BUI6'DING � ��, '
ADDRE55
_ . • ��. • ' , ',^ PER ISNO.
WNER �
' A.P. NO. / � ���
. . MAIL .� . " - • i BUILDING �70� n— ,�� �,
. ADORESS � ' - ' -/>ODRESS o Tv
� TEL. • �
. ' - CITV ' . - NO. TRACT ��Z 'LOT� BLOCK
"CONSfRUCTION � � ' '_ W' ADD A P M
I.ENOER "
. . BRANCH. . . � � . � 't OWNER(� �/! " /./�./G � .
ADDRESS�' . . •. ,. . ' ' . VAL E . .
' ARCHITECT ' ` ' �^'TEL. ., S G � S '
OP ENGWEER N . .
� . . . . . � FIRE � �
ADDFESS ' ' ' .ZONE TVPE' GROUP
" ' � ' � AVPROV
. CONTFACTOR� ° " � . . . BV' DAT� . ' �. .
� ADDRESS. . � ' ' � �
� - ' TEL. ZONE NO.OF' USE OF NEWG Z� '
CITV • .. � . � ' NO.' '. .
PLANS` BUILDING� �
F' STATE � - �� � CITV = �VARDSAPPROVED ' VARDS-APPROVED - '
,LIC. NO. • � ' LIC. NO." � MAIN BUILDING� + ACCESSORY BUILDING
� SIZE ' � ' - NO.OF B�DGS. (FROM G STP�EJE�T). ' , - ,
� 0. OF LOT � ' ' ' ' NOW ON �OT ' ' RONT �E7.'" .FT. �
. , � VSE OF " . . , .� . . � , f . , . . .
EXI5TING BLDG.'� � S E� . FT. FT.
�
F� = �. � Separate'peimits are �required for ' % . � u sioe - pT. `
, � electric;�plumbing and heating�work. ' REAR I pT. ���FT. '
W USE OF eUILOING AND WORK TO eE'PERfORMED � ` � -
OISTANCE BET. � BET. MAIN & .
� ' - MAIN BLOGS. = � ACCESS. B�DGS.
' �. i? � � . - � VAR.3P+ DATE . .
' a � - C.U.P.# ' ppPROVED � ' .
' � . " APPROV :�
a. , ' � -��
� 4 . � . � - . .. . . . . _ .
� I hereby acknowletlga that I have reatl this appllcation and�zteie � . , - ��'n
� p! that iha above information Is correct and 'aB�ee to comply wlth . _ �
- a all.lews ragulatfng tiullding construction, end I shall not employ . � . , ,
i
W•anY Person in violation of ffie workmen s compensation laws of ' - ' �•
,� Me'Stata of Califomla.. . . , . m
. 3 I hereby cer[Ify'�ffiat 1 em-properly licensetl as a contrector untler SQ. FT. ' ' �v �
tha Siata of Californie: Business and Profassions Code, Division 3, - THE AMOUNT SHOWN �UATION IS FOR m
- Chapter 9, and ffiatsuch lieenses are in full force antl affact, or.l � THE PUfiPpSE OF�E5TA8 PERMIT FEE N
am-adempt from the provisions of the State of Callfomia Business � a
VALUATION '. 'PE M FEE 8
. � end P�ofesslOns CotlB, Dlvision 3, Chapt¢r 9. .. �n '
m
' �' �, � V. PLAN CNECK E r o
' Signature of LL
. - Perm� . . . - . $/ - -TAX . -$' - . � ��
Authorized nt ' � � - � u
. 'TOTALPAID �$ � �
_ ,�._,-
`f 0T 53' TRACT 1F2 z
r�,
��;�39
CGSTA MESA BUILDING-SAFETY'DEPARTMENT
P.O. BOX 317 GOSTA MESA. CALIFORNIA
fOR APPUCANT TO F/LL /N COM�P�L,/ETECY
- • TYPE OR PRINT �'/- ��
6UILDING -/) �
ADORESS J
. 'COSTA MESA,,CALIFORNIA
owrvea� � K-& K DEVELOPMENTKCO.�. INC.
�RGHITECT � . � IIC. '
OP 'INEER 'FNONE : NO.
FEE RECEIVED
� SEP 271961`
FINANCE DEPT.
CIiY OF COSTA MESA
APPLICATION` FOR PERMIT
BUILDING
FOR OFf/CE USf ONIf'
I NECEIPT NO. I PERMIT
a r"r-�
I ED BY OA RECEIVEO / -Y-W(�TC.18:
�-'- I � ���0� �lCl�') •
ING � !
55
COSTA MESA, bALIFORNIA
ADDRE55 .ZONING .
LEGAL LOT C�3 �Z� Z I�NE � NO.OF U6E`OF NEW s%F J�h
OESCRIPTION I NO. � • I BLOCK ' i TRAGT R�J �' I P�ANS 2 ' I BUILOING W��
A.P. NO. . •• • . - BVPROVED� � DATE " /Z�I�I•
SIZE 6O X �OO rvo.oFe�ocs. YARDS EVES �
OF LOT � IHow oH�oT O REOUIRED �ALLOWED
USE OF � - NONE ' (CENTER LINE ST.1 ,J p '
EXISTING BLDG:' ��' FRONT 7 o FT.. IN.
SETBRCK LINE FFOM ' �� .
cENiER oF sirs[ET �" REAR YARD � R. SIOE � FT. / IN.
SIOE YARD I LEFT p� " � I RIGHTp � �� L. SIDE � FT. v IN. .
DESCRIPTION OF WORK . 1 �
REAR ' / � 'PI'. � IN. .
NE" I X'IIALTERATION�I • IIADDITION I �'��
REI I IIMOVING - I IIDEMOLISH I' ' �
BUILDING NO.OF � � � . "
SIZE ROOMS - H STORIES � �
EXTERIOR�WALL " IROOF' G�MP� �1 .
COVERING STUCCO * COVERING SHINGLE oe
USE OF BUILDING AND WORK TO BE PERFORMED . �� �
�SINGLE FAM � � �3
GARAGE � - , ,
1 HENEBY qCKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THpT THE ABOVE IS CORRECT AND AGREE TO COM- THE AMOUNT SHOWN fINDER'VALUATION IB FOR THE
PLY WITH r�LL CITY ORDINANCES AND STATE LqW3 REGULRTING PUflPOBE OF ESTABLISHING q PERMIT FEE ONLY.
BUILDING"CONSTRUCTION. VALUATION �j
SIGNATURE OF '. "�� /�� /i./ �. /�j� - PERMIT FEE $ ` ,� �
PERMITTEE t c�c
. • ' , ! $./���D�- PLAN'CHECK $ ��„�C
/,�
AUTHORIZED AGENT � � � TOTAL FEE S i/�i•J z