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HomeMy WebLinkAbout2923 PEPPERTREE LN - Building Permits' PACIFIC INSTALLERS, INC. 751�1 9ntho�v Avenue Gardea Grove, California 9264'I P.O. Box 728 , Westminster, Calif. 92653 State Lic. # c�-\ \�E,�l k City Lic. # 5�r- `F� Date / Customer �ame Permit No's. � i � - - i7� � J ��1.. , � City of � n��- Departmeat of Building and Safety Gent].emen: Please be advised that as of � all rrork by Pacific Inatallers, Incorporated, on the ermit numbera liated above have been cancelled. Therefore, Pacific Inatallers, Incorporated, requests that the pexmits be canoelled and that all pre-paid feea be retl�nded. This cancellation notioe ia advice to you tha.t Pacific Ixiatallers, Incorporated, hae no reeponeibi� for wor accomplished under Pezmits noted at oZ� �� 1� P� _ �/ ___.--.�t'� Very truly yours, PACIFIC INST9LLERS, INC. � ��. i i=�-•- PI-264 Rev. 3/74 , . . ' � ' ' Aoo�lcant to �ill in all spaces exeeot those within heavy Eoraer linas ane si9n all appro0riate tleclarations. ' • �._ _ _...__ - "._ ._ ' ._--.._._ _.. __. _ __ _ _ - PERMIT O. r � TRACTNO: ' LOTNO. .. ' ' ' '_, .__' '�' . _� -«--',"_(_ _ ..___-�- 4- � CIT�s%OF COSTA MESA� CONSTRUCTION-PERMIT' - ; � _ � : ; � ° u, �; ruNi� N6 ; ; ` � � - � . a � � ,q i ' _ �I 207; �, � . � , ti : mr ,�.,; ,, �a3i�a �� .: _ « ��.; �, �:,; , . _ ;��ie�ds..�� .��oc,' �� �"' � 2923� PEP,PERTREE; LANE�' � •''" � . . � � `' � ' '• ; � i . , i s . Prolect Address - - , . . .. _ . , ,�. �' � � � ' � � . -. .. ' A'� � � , � : - �.•• ' ,; I', j f 1 i �� -1 '-. TYPEOF,CONSTRUCTION , - !NEW ' ADD �ALTERATION REPAIR ' ' ' - -Appl¢an['s Mailing Addreu _ ` ' ' " ' y ( � . ' ... , , � � � . � , � - - � i L;� �:: r,❑O 'CONVERSION 'O DEMOLISH �'OTHER � � - q.p, #! , ' . ,-; j __ � t Zoae _ ��+ ' J 'Owner's Name �KATHY �SCHMIDT� . � � .. phone � N �' ' � - ' DESCRIPTIONOF WORK/USEOF BLDGr, FE-ROOF- WITH= CnPAPnRTT � �� � _ ! .. i jAddress � 2923/ PEP.PER`l'R$E� LAIV$, �' 4 =' . f'_ OVE ' . , ' ' ' 1 ... °{ ' " ' $' ' Bwlding' - � � � �' Accessory emld�ng ; � , � �Arch/Eng � - � �_ ' _ " � ' LiCense No. � � - t ' � TYPE OF;PERMIT i ,GaaoiNG FOUNDATION' _ STRUCTVRAL �` � ,�. FrOnt ! � � - ` _ : � p � '�Addre55 � � ' � � � � r ' ' � � ' � , ' ' � TENANT��O'ELECTRICAL ❑' PLUMBING O MECHANICAL� ' .;B Reaf. -- . ,i ' N I 4Contractor's'Name CAL-PAC�ROOFINC�'- ZN p��-S4$-$ OAa�'OTHER o � � -. 1 �: � . ' � i ; �- � � • � ' ; ' YA � `' ' _ � � E I: rPhonN .0 � Fii9ht � �_ � � � � � ; r' N ` :2220' S: =DUPONT DRIVE . !'- PROJECT�DESCRIPTION 5a.F7.•^ �- oCcuP,4NCK�S�� K; � � � � `Address (mailing) , , � ' q. i : ' L � 1 . Left ' i- ' � . ' . ='CONSTRVCTION'TVPE � �.VALUATION$' ',$, : . I . j �City�Licensenlo.tJ'2!633 � ^ _ � + - �� ZONE ' '`j � � GRADINGCV.VDS.� � ACRES� � � - � � ' � ' ' � ' ' �E L'ICENSED CONTRACTOR DECLARATION � � � � �- � PIOg. REf. #� I Parking Req./Provided ' ithereby'affirm that;l am licensetl untler provisions oi Charter 9 (commencin9� �Remarks:' � � . � � � � ' � i ' � � � � Pl2nning Notes: � ' ' ' , ' ' ' �� M f.with section ]000) "ot� Drviswn 3 oi the Busines5 antl Professions Cotle; antl � , - , ,. 'mY license is in full force antl effect. t . � ( � ` � . � � �. 1 ' � ' � i � . .� ' i ; : - i � ' 1 ' � � n i _ 1^ Tl � :iJcense c�I3ss � ' Li�nse IVo.3ZQ S (1 i � . . I ` ` (�p _ ' S PLUMBING � I FEES f � k Jp i�. � � � '�oate� 3/ 12 � �-oA��k�Y\ � . . " i ' � ' � '� ' � 'YORKERS'�COMPENSATIONDECLARATION �,-� � � � , , � , � � � ( � � � � . � � - BarSink � Showers" � , i � , � _ ELECTRICAL f � , • ; ;FEES . �,ereby affirm titat 1 Itave a certrt¢ate ot consent to self-Insure or a certificate' � Wotkers' Compensation Insurance, o� a certitietl copy-thereof,(Sectfon' BackflowPreventer �� -ServiceSmk� -=- � � 1 seoo, Lao, c. �- } � ' - ��' - i � Automatic Wesher; . Transformer �0 15 SO�KW =- -�-= -. � � �tCS137886� ROYAL f � � ,050+KW � � t Policy No. � Company � � � Backflow Irrigation , : Sewer Cap�� ��. � �� , Construction��Pole Sub.' { w � , , , ,y. QCertifietl'copy,is hereby tumishetl. , . � � , . . � , ���CerQ fi q�Gp py sj ile0 with the city Bµiltlin9 Di�ision} ; f 't� Bathtubs � � � Sewer Connection Cooking Unit � Meter ❑up to 100 amps i � Date � S�1L/ �b " APPlicant'� r-f�,-- �tj---�:.h�"+r'� , " , ' . . `. EXEMPTION FROM WORKERS' COMPENSATIpN DECLARATION ' Clarifief5 � . � - �Solaf ColleCtors { ' DishWasher ' M2ter ❑over 100amp5 j ' . �� (Tbis section neetl not be'completetl if the;pe�mit �s forbne huntlretl ($300) or ' - - � • � , .less). � � : � " - � • � ; ' Dishwasher� � � Solar Piping � : i Dryers ❑Gas ❑Electric Su6 Panel �.0 � I certify tha[ in the performance of the work for Which this perm�t is issuetl, I � � � � - � - :. � shall not employ'any-person in any manner so as to become subject m the Drinking Fountains �. i SolarTank� ' � 4 ' Fan � � , ' ��� Momrs �0.1 HP 01'/x,-8 � _ � Workers' Compensation Laws ot�Calitomia. , � . � . , -.. ' . Dare 5i9nature ' ' Floor Drains Swimming Pool w/Spa ' � F.A.U. ; � Ina Solar �9-15 HP�O16-15+. � � 'NOTICE: Ii, atter making Nis tleUaration,�you shpultl become subject to the � ' " - ' Workers' Compensation .provisions of tM1e. Labor Cotle, you mustforthwith . Floor.Sinks. _ _ .U�inal� . � . � ...- --...-�. _- + Fixtures� • �- � + - ' - � l � ,. _ ._ comply with such provisions or this permit shall be deemetl�revoketl. �� Microwave-:- CONSTRUCTION'LENDING. AGENCV ' � ' �.I ' ' �. ; Ga55ErviCer � Outlet5 � WaterCloSet ' � � r� � DevicCBoxes ' i � Pole�Ligh[ � �" • 1 hereby atfirm-thafthere is a construttion lentling agen[y tor the�pertormance �' � "1 " ' of •tbe �work ,for which this,permii is issuetl (Section 3097-Civ. C.)� � " , � � - � � , i . Lenaer�s . rvame z� � - `�' � . :. Interceprors ,Water�Heater �; _ • � � � , , •,' : . Outlets , ,i- ' � �� Fiange ' ' � ; - . , �- - , ? �entler's Adtlress � � . - " - � - � � - Kitchen Sink - - - - �" � Water Serwce � , � -� � . r� ' • Switches �- � , Sig� � . ,r � . OWNER BUILDER,�EGLARATION ' - ' � � � � � ' � I hereby affirm that I am exempttrom`the Contractor's License Law for the Lavatofies '., � i _ �- Auto-Wash' �� �' � J' ' - ! � ' following reason (Section 7031.S.Business antl-Professional Cotle: Any dty�or ' °' � ` - , � � Garbage.DiSpoSal � ; � , Stending Sections . ' county. which requires a�permit to,construct, alter, imptove, tlemolish or repair , � P-Tf3p � �� � . � i. �� Caundr T�2 5 �� �� � � � , � � . ��any stlucture, pllor to its issuance, also'requires Yhe applicant for,such permit ' � �� C'� � x y y_ ,y , � G¢nCl2tOf �0-5 KW 05-15•KW TfBSh COflip2ctOf . to h�e a signetl statement that he/she is licensetl pursuant to the provisions of r - � �, • �� , , - . � -�e Contractor(s Llcense�,Law'(Chapter 9(commeqcing-with'Seccion 7000) of Roof Dreins' _ . � �ision 3' ot the Business antl Professions Cotle) or-that he/She is exempt - . , r 5 _ � � ' � � � � � ` � ' � �efrom antl'the ba5i5-fo�.the allegetl exemptlDn.�Any violation ot Section � � . ' - � � ' -, � » . . � ' ' , � . . ! j- �31.5 by.any applicant.for'a. permit subjec�s the. applicanf to_a civil Y •'' c� � " ' � ' ���' � '� � S , � � � enalty of not more than five hundretl tlollars ($500). i . i ' � ' ` `" � ' � - � -� ' i • � � � , ' ' � - � I, as owner ,of the pro0erty �or' my; employees witti wages as their sole Reinspection Fee � $15 ' � ISSue Fe6 � $ �3� ; ' ' ' ; � ' , - ' compen5ation, will tlo the work, antl^the structure is not intendetl;orofteretl ' Reinspeetion�Fee � $15 ISSU¢ Fea � ' $ 3 • for �sale (Section 7044, eusiness.antl_Professional Code: The Contractor's' : �_ . �� ' - . MECHANICAL . FEES� � �' License�,Law tlaes noLapply to an owner of a p�operty wha.builtls or impwves . � ' � . , - - tbereon, antl who does such.worbhimself/herseli or throu9h his or her own � - - • ,,� DEVELOPMENT SERVICES REQUIHEMENTS: . � � Boiler � ^ � ; Hood or Type I ❑ , . � t ' ' employees, providetl thai such improvements are not intentletl or offeretl foq , ,; � 7 . � sale: Ii, however; the builtlin9.or improvement is�soltl within one year ot�mm- , � Canopy Type II ❑ � .'-� ' Zoning Approved By ' ` Date' pletioq tne owner will have tne burtlen ot provirjg he/sne tlitl noc builtl or im; Duct - Under Ground � . � � !� - , Building Approved By � � � � � Date � � erove for the purpose'of sale). � , � ,. � . „ . . , i � � � . LJ I, as owner of.the.property, am excluiively contracting witn licensetl con; Duct � SVuctural ' Refrigeration System � ":• • � � Appliption Issued By - � � nat 'e--��� [�actors to construct the project (Settion 7044„Business antl Professions Cotle: ' , � The Contractor's License Law tloes not Spply. to an owner of property who Duct - Ventilating r ' ❑0.100,000 BTU ❑700,000 BT.0 , ; ; . ( i ', ' SUm A V OF FEES � � . � � �builtlsjo�� improves tltereon; antl'wM10 contracts ior such�projects'with-a con- � � - -- �� - ' ' - �" - " - ' '-" -' ` - . � L� ��Q� � tractor(sl license pursuanLto the Contractor's License Law). I�am aware that i� Exhaust System ❑�MWtiple ❑ System Repair/Alteration ; �- �� } � t � BUILDING PERMIT. $� ' , SMIP ; �,$ i � ( proof oi thert Wo�ker's Compensation insu�ance shoultl be provitletl to me. � ' • ' ,�I ��__ � PLAN CHECK' $. � ' � PERMIT, ' � I am exempt untler Section , � B. &�P. C: for this reason� � Firepl/FacL BIt. ICBO # � Pire Dampers � � � � PLUMBING � } $� � � i ' ��UANCE � $ � ^�To�o- Date � ' owner • � � ; . • Heating System & Ducting. Registers � � ' � j . PLAN CHECK � 25% $ ENERGY P.C. $ � � ' " ' , -I-heretiy <ertity;that I have-reatl this�applicatibn 5ntl�itate that�the above:,- ❑O�100,000�BTU 0100.0008T �- -� ' ELECTRICAL� � GRADING � $�- ' ` iniormation'is carrecL I agree to comply with all city antl wunty ortlinances- . ' � � � � _~ • $+ . , � + -r . antl state laws relating to builtlin9 consiruction, antl hereby authorize re0re- � , � � � ; • � V � � � � , i � � � MICROFILMI $I '� � zentatives of this city to• e ter upon the abOve-mentionetl prqP ertyj tor. ! i � � ' . • f - , PL�N CHECK � 50% $; ; �. inspectionpurpo�ses. ���,� ^' • � �!�/� y1�j- ' ' � � ' �- � ' '� � ; ( � ' t MECHANICAL � $�- �TOTALPEE� $(� Signature '�l..a��—,T�`�^�`�'� "�`� � oate )/ 1 �I�V`�/ � . - . y. , � Orivers' License or 55;� ��� �- - o- Fee � -� $15 I- laue Fee i , ; $ 3 � PLAN CHECK 25% i �. � j � a i . ' r _... .. . � .� .��..� . ._. ..��_�... '. . • "�.. �... .....�.�._. �.•i J L _ . , �V / � CMF 0865-4fi, rev. 30/84 White - Bulltling; Canary _ qpplicant; Pink - Accounting; Goltlenrotl - AsSessor � �e✓��-'� � 1 "'� 5A \� - � . ' _ �� � �i 2. ��] \ .. . 1 . . . . , 1 ` . �....T_.._.. .__. � .- ... . . _. ._ _ . _POf "SPA - _._. . . --'-r CONSTRUCTION�AND PLANNING� � � . - � � .- - . �'��' " � • ` Date- �-lnspector • � ' - �'Date Inspecto�= ' {zf•(.4PPROVALS � Permit #�� ; -�, APP.ROVAIS' Permit #` . ,�. � � �� - - - - "1. Temporary �Electrical.Service orPole ' . 52. Pool & Equipment Location = . - o n _ - - ry�,2."�Soil Pipe-Undrgrnd.' � ' �' -- � 53. Steel Reinforcement, � ^ " i. - ' .�3. Electrical Conduit Utility�Undrgmd: � - � .� . 54. Forms �. � . . ti � { `�4. Electricaf Conduit,Undrgrnd.�:: � ` � - . _ ' :55: �Elect�ical Bonding � , � � � � � � 5. Steel Reinforcement � ' Y - ,- � � � �56. Rough Plumbing & Pressure Test� , . . - ,' .r - ; c�6. Electrical UFER Grnd. � � � �' ��� �' � ` � �57. �APPROVAL TO COVER-GUNITE . . �'i ? � ; �I�,7. Footingsi � , • t ��;, � ` � " � - ' �i ; ; = �58.� Electrical Conduit-Undrgrnd... � ' • .i,!" � � � -8. Foundation� � ; i ' • ,_� `: � � °' ' �` . �59: Gas Pipe', 0' Undrgmd., Test<� `�� � �'� j c" .t��. . � i � i �c �. . . �'9. .Water �Pipe-Undrgrnd: � � ` ' � ' � ' ,� 60. Backwash L-ines; P-Trap; OrUndrgrnd.- ' " '� �' ` � y- + � y I i �' � �f 10.,,Structural Floor System, - ; �'` � � � .' � 61: �APPROVAL TO DECK - ' � _ � � a �. z ; �ci,. Pro'perty Sewer Line & House Connection` ' _ , -. � 62. Backwash & Receptor-Final ". � � . - - � � ' .,12. Sewer�Cap I . . � � . . � , � . i ;.. . . . . . , � , �; -r . 63: Heater&Vent-Final � t'�� _ ; 13. Roof Drains� " � � . . � - � ` `64:�Plumbing System�-Final `• � , . . Y..�; � 14. Rougfi Plumbing � ' � - . � - > ,. ' ' '65. Electrical-Final `� . - � � ' ' ' q - - �� o `�75.,Rou h_Electrical-Conduit � - -( v - � 9 - . . . � _ __ _. _. . . . _66. Solar System-Final _. . . _ _ .,,, �16. Rou h Electric Wirin `� � � � I � � ' � � �' � �;' 9 � _ 9 ; � � . . _ - . 67. .Fencing & Access Approval� _ _ ,._. r_ .._ _ - � �iZ. �Roug �Wiring Sign,� � � � � � � , � , � � ,68. APPROVED FOR PLASTERING ." � ` ' �; : {-18.,Rough Electrical;T,:Bar Ceiling �� � ' � � � �� �69. POOUSPA SYSTEMS FINAL • . • ' � � � 4 � � 19:�;Rough;Heating & Air,Conditioning ' � � i i ' FIRE DEPT..REQUIREMENT , � � � • ', � 20rjRough Factocy Fi�eplace � ' '� �. � � '- ; ' " APPROVALS � Permit # ' � - �� � ' � � � "` .. ' , 21`. iDucts,�in Structure � � � j : ; ! 70. Underground Hydro � � . - �� t _-( ° '_22���Ducts,.Ventilating _. . � ' � . � � , E '7�. Product Piping O Gas ❑ Oil � � ' . _ � i ;'�23.lGas Pipe-Rough & Test'� ' '!, - •t� � -. - - - •- - �.72i Underground Flush - � � •� �' - � � � - - ';--- --'i � e I'24.�lRoof Framing: }. � � ' .I�" -��"' •_ - . ._ . _ � � � - - -�--�- - ,i ; �� i � I+ , �, _ �; f .73. Undergrnd�. Storage,Tank � Gas ❑ Oil � � ' 25.4Roof Sheathing � � i h� �' � ` - 74. Ope�head Hydro � ' ' � � ' i � � � - , � � _ , �.. . . � . .� � � � �-,� � . � +� ' 26. ��T=Bar Ceilingi�Str,uctural) & Monocoat { � � i - ; � � � '.I = , ,75. Dry Chemical � 'S • ; ' i � i � � t ,_ ��27. *�FFame and Flashing� ". , � � �i ' i t . � � : '76. Dry Standpipe � ! � ' '- � �; �� + , a � �`28.�Lathing &_Siding' �� ' • j� �� � � � � � '- j '77. FIXED SYSTEM FINAL . ' � � � � � . 29.�Insulation ; :� � � i� � ' ! � , ' '78. F�IRE PREV. FINA�L � � . ( _30yDrywall Nailing � r � t ;, � � � � � � � . � � HEALTH DEPT. REQUIRENIENT' � � � s � 31.�Plaster Brown Coat y � � �",�"`i "" '� -�'- ' ,- '� " --79: FINAL INSPECTION•- � � � � - - � - ,- ��---, -•�.. �32.�Electrical Power Meter-Final ; ��.r,�! � � ' { � t � !80: FOOD CER�TIFICATE ISSUED � - � w % � � ' 33.ZFinal Electric � � , ' � " -- ...� � . y--:- j' 'Notes�- ,--a -', -- .y.,. . ; - -.-- � �.- ; -a-_. � _ ' �a� s:� -. . .__ . . _ .... .- . . . .- .� r --- . _. - -• - - z� � 34. Final Heatingi&;Air Conditioning« ' � ' ' �� � _ ' - ' �" "�� i �~ , i i ••'_'i�-- '- - - - ' _ -_r ..�: _�- _ . 35. Final Gas Pipe=Test� !. ; � � q � , I i _ �+ } ' i 36. Hood or CanoPY ' i ' �. � � '� � � � ' i : � s V � � � ` I • � ,- � � � � ' � - _ ` � T � q �: 37. Final Factory Fireplace � � � � - � �� � i ' . � ! � � � ' � ' � - � - ;' ,r '! �� � � I � i n :i i ' , _i. .+ � 5, 38. Final Pluinbi'ng � ' j i � � � ; � - I _ ' . 1 j � . - 1 " ° . - _ � ' '�z r,Y U 1 r� 39.WaterlService�Finall ' �;�� � j �.t � - � . � � ' i � ',_ �- �• �� �:±�� 40. G''as Service-Final � . � � i:.-'� ' � ! f � � � ' � ' �� � � � �� � li� i � I ' � � I � 1 ' 'r .�� ' y'� '�� 41. Solar pomestio-Final i � , � � �- � ` ' i � , � • � ' : � � _ „ � ' ' '� � � ��� i^�i�� �.� e ., i i �:. 42. Backflow Preventer� , � � `. '' ' � i �I � � t � � � � � i �� , �,; , ,� ' ' . . ' �.. . ; � r „ 43. Backflow'lingation -.J_ j � `,,,' , - -T��' (-' i ,__ - - : i- - . --1_� ,. 'r' . '•-.' ' i: : 'r�i : ; . � � �44. .Landscape Irrigation System � , 1� � ( � �` �� � ' � � , ' � % ; "`� � � ' � �4� 45. So�und �Attenua'tion - � r 1 "r '' � � � " � . � � ' � � ' � � i .. . •... " ;i � � . . . ' � � � � ; �s : �, ,46. Handicap Regulations � � � ��- � ' '. � t � '� - L �� y 1 , � � .._: � � • i �, ^ - 47. FINALSTRUCTURE&;BUILDING! ���� �'�! ! ; `�, ' � ' '` ' � � - " - . ` r r-. � � . 48. Speciel Requireinents Completed � ' � � j � �� ^ � t' j i � ; � � '' � � �, ,r � _ ; . . �, 1 49. ElectrkicReleaseto;Edi'son� � � _..,�,�.j j_. __�.�..�_�_ _i-. . �_ � _L.�� � '�tryi ' . � 50. Gas Release to Southern Califorriia GasC� i � ' i � ' � ' ' ' � - ' • "• " 1 I ' 1 I ' •r� II )�i fIi 51. CERTIFICATEIOF OCCUPANCY � '� : � , , - � � ' � ; ` � , , ' , , 'v 's �.._.._...�.t .1... . ::�i =. _ - �'�-� . . --r'' ' --r � -. • '. -' � ' � � . �`= i No. � �: - - :Date ' � . , � - -- - - � � � ' � � '' �� � � owN�R N�YLENE, INC. DATE b-16-59 aos nDDaEss 2923 Pepper Tree Lane suiLnirrc rExMiT xo. 9632 GENERAL CONTRACTQR Dike & O1gT'OVe VALUE $1 �387.00 . AP. No. LOT�9 TRACT 2 22 FIRE 'LONE DESCRIPTION OF WORK R2S. W 3t ,gar. I! 'ECTIONS .7,p_� _ u I DATE SUBCONTRACTOR Form 4 `S� �9�2 � � � ��� 6��C���JL� . ' JUiV i 8 9959 � C057A MESA BUILDING-$AFETY DEPARTMENT " rlar�n ! � r � P.O:BOX 3f� ' COSTA MESA, CALIFORNIA . ��"�r��1L�� `�� ��• . r 1�. �l;' ��!'���.^' Tj_( . l fOR APPUCANT 70 f/CL /N COMPCETECY wPP�icwrioN FOR PERMIT TYPE OR PRINT � � � � BUILDING � � BUILDING � � � - � ADDRE55 2 2 Pe e ee e t r �/ COSTA MESA,. CALIFORNIA � FOR OFFICG U�G ONL7 ' t �r � RECEIP,T NO. P.EPMIT NO. � OWNER LeIlE 1RC. ' I I - �j<�'��� MAIL � ' RE EIVEO BY /DqTE RECEIVEO TE I65UEO ADORE55 E. -1 th St• � I ( -/�� � . � � ��-�'J CITY =� COSt.a. M2S'd TN�.�pl159 BUtLDING - ADDRE55 oR� '�EER ' Carlson & N�o COSTA MESA, CALIFORNIA " FIRE • ADDRESS GS CLBTl ZONE � D�E PY COZCpT'OV8 I71C• STATE t APPROVED " - CONTRACTOR � � LIC.NO. 16�Z BV ' OATE ADDRESS � y�/ F+• -17W1 Ut. �Costa. Mesa ' � � �'Z�NWG � � LEGRL ' I LOT � r� I I- '�'z'� ZONE . I NO. OF I USE OF NEW OESCRIPTIorv NO. � L BLOCK TRACT PLANS 9UILDING . APPROVED' ' �r:., A.P. NO. BY DATE �t SIZE L .�n I n0. oF eLocs. ypRDS EVES OF LOT W yV HOW on�oi REQUIRED. ALLOWED USE OF � ' (CENTEft LINE ST.� � EXISTING BLDG. FRONT . J F7'. IN. SETBFCK LINE FROM � c[rviER oF siReET . O� • REAR YARD 2 � R. SIDE .S FT. IN. SIDE YARD ILEFT � IRIGHT t� �� L.SIDE J �7. IN. DESCRIPTION OF WORK - • � REAR FT. ' IN. ' NE\ �I X II ALTERATION I II ADDITION I ' ' REPAIR I II MOVING I II DEMOLISH � I BUILDING ' NO.OF � SIZE ROOMS STORIES EXTERIOR WALL1 � ROOF � �_ � . - �. COVERING SYIlCCO ICOVERING ' USE OF BUILDING AND WORK TO BE PERFORMED . � . Sin le £amil residence • � vaith attached garage. • I HEFEBY ACKNOWLEDGE THAT 1 HAVE PEAD THIS �1PPLICRTION THE AMOUNT SNOWN fINDER VALUATION IS FOR THE AND STATE'THAT TNE ABOVE IS CORRECT ANO pGREE TO COM� PLY WITH ALL CITY ORDINANCES RND STRTE LqWS REGVLRTING PUFPO6E OF ESTABL�SHING A PERMITi FEE ONLY. Bl11LDING CONSTFUCTION. ypLUATION ' SIGNATURE OF � PERMIT FEE $ 3�.�,�OO PERMIiTEE � � . $ ri PLAN CHECK $ 1�]�� AUTHORIZED AGENT_ D].]re � � ���o� TOTAL FEE $ 1 Q � . _ . . .. . , .