HomeMy WebLinkAbout245 PRINCETON DR - Building Permits( � ♦ 1
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.BUILDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626
JobAddress: 245 PRINCETON DR
Suite:
Vicinity: RESIDENCE 8 ATTACHED GARAGE
Parcel Number: 14139308 2oning:
Applicant: SALMON, FRED S
Address: 245 PRINCETON DR
COSTA MESA,CA
owner: SALMON, FRED S
Address 245 PRINCETON DR
COSTA MESA, CA
Contractor: OWN ER-BU I LDER
Address:
Zip:
Arch :
Address:
Phone: 714-044-0429
Zip: 92626
Phone:
Zip: 92626
Phone:
License: 0
Eng:
Address:
ISSUED BY:
StaWs: ISSUED
Applied: 07/13/2001
Issued: 07/13/2001
Phone: Phone:
Zip: License: License:
SCOPE OP PERMIT.
. REROOF: T/O ROCK ROOF, REPAIR SHTG AS NEEDED, 2 LAYERS OF 15#�FELT, 30-YEAR COMP SHIINGLES.
2000 SQ FT , , r
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total:
SETBACKS
ACCESSORY
PARKING
NOTES:
$0.00
$97.25
$0.50
$0.00
$0.00
$0.00
$97.75
�' „
Front 0- 0 Rear 0- 0
�
Front . 0- 0�� Rear 0- 0
Ezistina: 0'� Reouiretl: 0
FEE SUMMARY .
- - Calc Valuation: $3,eoo.00
Claim Valuation: gs,eoo.00
PLANNING& ZONING, F " ' �'
Lek 0-0 , Right 0-0
�Lek 0- 0 ' Right . � 0."0
� Proposed: 0 - �
NO710E: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRA710N: This permit shall automatically azpire and become void it work is not commenced within 780 days, or if work is suspended or abandoned
tor a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
�� reqWred inspectlona and final approval must be obtainad. Failure lo obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
�ba6d6 (6�Op)
r
WORKERS' COMPENSATION DECLAANnON:
I hereby affirm untler penalry of perjury one of the tollowing declarations: � ,
❑ I hava end wlll maintain a certitica�e of consent to selt-Insure lor workers' compensation, es pmvided for by section 3700 of the Lebar Code, far the pertortnance oi the
work lar w�ich this permit is issued.
❑ I have erW wlll melntaln workers' otlmpensation insurance, as requiretl by section 3700 of the Labor Code, for the performance ol tha work for which Nis pertnit is issuetl.
My workers' compensatlon Insurance cerrier end policy number are:
Certier. � Policy Number: -_
(This section neetl not be comp/eted i! the pe�mit is veluetl a! one hundred dollars ($100) ar less.)
❑ I certify thet in the pertortnance of the work for which ihis permil is IssueQ I shell not employ eny person in any manner so es to become su�ject to the workers'
compensetlan laws ot CalNomla, e�tl agree Ihat il I shoultl become sub�ect to ihe workers' compansation provisions of Sectlon 3700 0l the Labor Code, I shall forthwlih
cnmply with these provisions.
Applicant SigneWre: Date:
WFRNIN�: FAIWRE TO SECURE WORKERS� ��PENSATION COVERAOE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOVER TO CRIMINAL PENALTIES ANO CIVIL FINES UP TOIXJE HUNDRED
TFqUSPNO DOU.PRE (EtOU,WU�, IN P➢OITION TO TME COST OF CaMPEN5AT1�1, OPNAGES lS PROVIOEO f-0R IN SECTION 3NBOF TI{E IABOR C(YJE, IMEREST, AND qTTpqryEy'S fEES.
LICENSED CONTRACTORS DECLARAnON:
I hereby affirm ihat I am Iicensed under p�ohsions of Chapter 9(commencing with Section 7000) ot Division 3 of the Business entl Prolessions Code, entl my license is in full
torca antl eflect. Llc. a Class N
Coniractofs Signeture: Date:
CONSTRUCTON LENDING AGENCY:
❑ I �ereDy aNirm t�at thera is a cons�Nciion lending egency for the peAormance ol the work for which this pertnit is issueG. (Sec. 3097, Civil Code).
Lendefs Neme: Lender's AtlCress:
SigneWre: Date:
OWNER•BUILDER DECLARATONS:
I hereby eltlrm ihet under penelry ot perjury Ihel I am E%EMPT FROM TNE CONTRAC70RS LICENSE LAW for the following reeson (Sec. 7031.5, Business end Professlons
Code: Any ciry or counry which requires e permit to construct, elter, improve, demolish, or repair any structure, pnor to its issuance, elso requires the epplicant for such pertnit
to fila e signetl ffietement ihet he or she Is licensed Dureuant to the provislons M ihe CoMrectors Lfcense Law (Chepter 9(commencing with Section 7000) oi Division 3 ot ihe
Business antl Pmfessians Catle) or that he or she Is eaempt t�ereirom and Ihe basis for the elleged exemption. Any violation at Sectlon 7031.5 6y eny epplicant for a permit
�� ub'ects tha epD�icant to e clvil penalry oi not more than five hunAreO tlollars ($500).):
I, es owner af Ihe properry, or my nmployees with wages as their sole compensetion, WILL DO THE WORK, end the structure is noi Intendatl or oHered lor sale (Sec.
'\ 7044, Business end Professions Code: The Contrac�ors License Lew tloes not epply lo an owner of properry who builds or improves �hereon, ana who does such work
himself or hersell or ihrough his or her own employees, provitletl t�at such impmvemems are not intended or oHered br sele. II, hawever, the builtling or improvement is
soltl within one year of com0letion, tha owner-builder will have tha Durtlen of proving Ihat he or she tlid not build or improve tor purpose oi sale.).
❑ I, es owner oi the properry. em E%CLUSIVELV CONTRACTNG WITH LICENSED CONTRACTORS to consiruct Ihe projeci (Sec. 7044, Business end Professions
Code: The contractors License Le�� does not epply to an owner ol proparty who builtls or Improves thereon, antl who con�rects lor such project with e coniractor(s)
license Dursuent to ihe Contractors ��ense Laws.).
❑ I em exempt ur�0er sec. Business end Pmlessions Cade tor this reason:
Signatura: �4 i /p Date: '�
Owner ID verilied by drivefs license. ❑ Ves ❑ No Drivefs License No. Eapires:
Vedfication ol Ownership by (type of tlocumem, i.a. - pmpeny tax �ill or tleed):
DIVISION OF INDUSTRIAL SAFETY PffAMITCERTIFICATiON:
❑ I hereby cetlily thel no ezcavetion live (5) or more feet in tlep�h into which e parson is required to descend, will ba made in connection wi�h work euthorized by ihis
permiL snd ihet no building structure, scaHdding, talsework, or tlemditlon w tlismantfing lfiereot, wifl he more than ihiny-six (36) teet high. (Chap. 92, Grp 2. Art 2. Sac.
341, Tl�le 8, Celifomle Adminl5trati�e Code).
❑ As ownerbulltler, I wlll not employ anyone to do work which would require e permit imm ihe Division of IntlusMel Sefety, es notetl above, unless such person hes a
pertnit to do such work from the dihsion.
Signature: Date:
Division oi Intlusiriel Satety Permit Numbar:
CERTFICATE OF COMPLIANCE AND AU1I�ORIZATION OF ENTRV: I certity under penalry of perjury that I heve reed this application and sta�e ihat ihe information given is
wrrect I egree to comply with ell state laws antl ciry ortlinances relating to 6uiltling construction, antl authorize representa�ives ot t�e Clty of Cwta Mesa to en�er upon the
above-described pr rty tor m pection ose I egree not to occupy or ailow occupancy of any building authorizetl by this per t untJ fi I inspection.
e,� Q .� ,�1�.,r�„�� 7i'/�o r
��ignature LegalOwner(s) ate
And/OrAu�honzed Applicant Date
COOE �. INSPELTION TYFE
1616 Fixed System Final Fire Preven�ion
1266 Pool Spe Finel
200 Final Re-Rool
201 Finel BIocWReteining Wall
202 Final Factory Fire Place
203 Finel Sign
204 Final Demolition
P� ItIIID9L5
COpE� INSGECTIONTYPE
206 Finel MechaniCal
208 Finel Plumbing
2t0 Final Elecirical
212 Pinal Fire Pravention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupency
D� 1t�Je45
�
Property Profile
Property Profile
Geo Leve(: 0
Property Clearacteristics
Bedrooms: 4
Bathrooms: 2.0
Total Rooms: 8
Zoning:
Heating/Cooling:
Sale & Loan brfonnatiox
Transfer Date: 04-13-1994
Transfer Value: $217,500
First Loan Amt. 5195,750
Loan Type:
DataQu��'ckr
�.��,Y��������,.
Primary Owner: SALMON,FRED S& JENNIFER L
Secondary Owner:
Mail Address: 245 PRINCETON DR
COSTA MESA, CA 92626
Site Address: 245 PRINCETON DR
COSTA MESA, CA 92626
Tclephone Number: (714) 444-0429
APN: 141393-08
Reference APN:
Census Trach 639.051
Housing Tract Number. 3187
Lot Number. 17
Page Grid Old: 27-D5
Page Grid New: 859-A7
Legal Description: N TR 3187 LOT 17
Subdivision:
Year Built: 1957
Garage:
Fireplace:
PooVView:
Seller:
CosdSq Feer. $142.90
Lender. Sc Funding
Interest Rate Type: F
Assessed & Tax /nforniation
Assessed Value: $255,245 Percen[ Improvement 27.11
Land Value: $186,048 Tax Amount: $2,862
Improvement Value: $69,197 Tax Status: curren[
Square Feet: 1,522
Lot Size: 9,270 sq ft/ 0.21 acres
Number of Units: 1
Use Code: Single Family Residence
Document 0000258416
_ ..__ ..._ ._._ .. _.
Title Co.: Firs[ American Tide
Last "frans W/O$:
Las['Crans W/O$ Doc:
Homeowner Exemption: Y
Tax Rate Area: 15045
O 2003 DataQuick Information Syslems. T�is information is compiled from public documents and is not guaranteed.
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�
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attributes : Costa Mesa Parcels
Property Address
• Address 1 245 PRINCETON DR
Address 2 COSTA MESA CA 92626
Parcel Information
Assessor Parcel Number 14139306
Legal N TR 3187 LOT 17
Range
Township
Sedion
Quarter Section .
Area
Acres
Owner
Owner Address 1
Owner Address 2
Vear Built
Building Square Feet
Building Count
Stories Number
Parking Spaces
Number of Units
garage Square Feet
Front Footage
Depth Footgae
Bedrooms
6282.8446599999997
0.14000000000000001
Owner Information
SALMON FRED 5
245 PRINCETON DR
COSTA MESA CA 92626
Property Specs
1955
1527
1
1
2
0
0
100
65
4
Page 1 of 1
http://mesagis2x/website/costamesa/parcel/default.asp?opt=attributes&sessid= {538B885F-E92A-47BD-... 10/31 /2003
\1
1
Applicant to fill In all zpacas oxeapt inose wilhin neavY bortler Ilnes ane sign all ao�ropriate eeelaratlons.
CITY OF CDSTA MESA ONSTRU TION PERMIT PER T 0 TRACT NO. LOT NO. UNIT NO.
Project Address S�-L :— � _ '.d11—
Applitant's Mailin Add 1��
\'{(��}�T �-� .
Owner's Name � `^ � ` ��( ,p PhOf1C-75 �C�Zr
Address T�a-Y� L�
Arch/Eng. License No.
Addreu — �
Convncror's Num� y� e
Address (m� �'��� I
Ciry License Nn. l 7
LICENSED CONTRAGTOR DECLARATION
1 Ite�eby al(Irm that I am Ilcensetl unde� p�ovislons ot Charter 9(commencing
with section 7000) 01 DIVISion 3 of Ihe Business antl Protesstons Cotle, antl
my licenze is in full ana eifact. /
LJcens 55 �6 58 <
Date 519nature
'�ORK RS' COMPENSATION UEC RATION
aereby attirm tnat I have a ttrtilicate of consent to selNnsure or a cerUficate
� ot Workers' CompensaHon Insurance, or a certifie0. �c.o/p�y roereot (Section
�I 3800, Lab�l^�� o^ �.I l.� �1/i��
I Policy No �-1 o/ Company�
ertlfiea copY �s hereby turnishea. ,�,/� )
Cer tiled with the City Itl' �)'�i�.Pn�'� (// � ,�
��; Da[e� APPlicant��/ vi . �-' �l!
I EXEMP ION FROM WORKE0.5' COMPEN ATION OECLARATION
�� (This section neetl not bo compbletl if the pGrmit IS tor One huntlrltl (§300) or
Icss).
��. I certity that in the perfo�mance of the wOrk fOr which thi5 perm�t is issuetl, I
�' Shall no[ employ any person in any Tdnner so as t0 become SUDject to the
Woikers' Compensatlon laws of California.
Dale� 5�9�aturo
NOTICE:It,afcer makln9 this Ceclaratlon, you shoultl become subject to the .
Work¢rs' COmp¢n5ation provlsions ol the LabOr Cotle, you mu5t forthwi[h
comply with sucM1 p�ovl5iOn5 Or Ihiz plrmit zhall bC aeemea revoketl.
GONSTRUCTION �ENDING AGENCV '
I hereby alflrm that tharo is a construclion lentling a9ency tor the performance
oi [ne work for wnicn thls permit is issuatl (Section 309�.Civ. CJ
L¢ntler's Namu
�entleYi Atltlress -
OWNER BUILDER OECLARATION �
I nereby aHirm that I am exemp[ irom the Contra<tor's Ucense Law tor [he
following reason (Se<Non 7031.5 Buslne55 antl Protezsional Cotle: Any ciry or
county w�ich requiroi a Oermlt to tonztruct, alter, improve, tlemolisn or repair
any structuro, pdor to Its Issuance, also reQulres the applicant for such permit
to fim a Slgnetl statement tnat no/sne i5 licensetl Pursuant to the provisions of
'ne Contractor's Licenie Law (Chapter 9(commenUng wilh 5ection 7000) ot
)IvisiOn 3 0l the BUSlness antl Pro/aislons Cotle) or tha[ he/ShG is exempt
.ncrefrom antl [ne basis for [�e allegetl exempUon. Any violation ol Section
]031.5 by any applican[ lor a pa�mit Subjettz tne aoo��caot Io a clvil
�endlty of not more lhan livn hundred tlollars (E500�.
1, a5 ownar ot Ihe 0/operty Or my employee5 with wages as lheir sOle
com0e�3���On, wlll tlo tha wOrk, antl the SVUCturO ii nOt Intentl¢tl Or Otferetl
IOr sala (Section 7044, Business antl Pr01¢silonal Cotle: The Con[ractor'S
LiCenS¢ I.dw Ooes nol apPly t0 an owner ot a properry wlio builtl5 or improves
t�ereon, antl who Ooez sucn wark nlmseli/hersalf or tnrou9h his or har own
employ CeS, Provltletl tnat such ImprOvemOnts are not intCneetl or otteretl tor
581¢. I/, howover, lhe builtling or ImOtovement IS 5014 witnin one y¢ar ot com-
pl¢liOn, tne ownBr will hava the burden 01 provin9 he/sho tlid no[ builtl or im-
�rove for tho purposo ol sale).
I, a5 own¢r ot [�e p�operty, dT exclu5ively cmtratting with licenzetl Wn-
trac[oR t0 consV uct the prOject 158ctlon 7044, BUTInGzS antl Professions COCe:
Tne Contractor's LJcense Law doc5 not appry to dn owner ot property who
builtls or improvas thereon, antl wno coneracts tor sucn orojects wltn a mn-
tractor(s �Kense oursuant to tho Contractor'z Licanse Law). I am aware that
proof o� tM1eir Worker'S COmpenSdtlOn iniuranG! ihOultl be prOvltletl to me.
❑ 1 am exempt untler 5ectiOn B. S P. C. tor IhiS rea5on
Date Owner
I hereby cer[ify [hat t havo rea
Info�malion is cOrrect. I agree t0
antl stale laws relating to builtlir
sentaiives ol this city to onter
inspettion y4r�a5ga�A� ,q /J
$ignature � if� 1 r � / (�
� Drivers' License or 55 � —!�
tha[
fY
� �7 3a
TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER A P *,
DESCRIPTION OF WORK/USE OF BLDG.
S Main Buildi
E
TVPE OF PERMIT GRADING OVNDATION STRUCTURAL T Front
❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL B Rear
❑ OTHER A
PROJECT DESCRIPTION Sq.FT. OCCUVArvCY C Right
CONSTRVCTIONTYPE VALUATIONS g Left
ZONE GRADING CU. VDS. ACRES Ping. Ref. #
Remark�: Planning NOtes:
Sink
Irrigation
rinking Fountains
loor Drains
loor Sinks
as Service � Outlats
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Reinspection Fea � $15
Boiler
Duct� Under Ground .
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Mul[iple �
Firepl/FacL Blc IC80 #
Heating System & Ducting
❑4100,000 BTU 0100,OOOBT
Rainspection Fee � $15
CMF 0865-46, rev. 10/84 VJnite - Pink - Accounting: Goltlenrotl - Assessor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
$olar Pipin9 '
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
Issue Fea
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration Sysiem
❑0-t00,0008TU ❑100,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
5 3
$ 3
Auromatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher ,
Fan
F.A,U.
Fixtures
�evice Boxes
Outlets
Switches
Garbage Disposal
Generator 00�5 KW
Fee
9135 6/']5/�'7
2ona
Acceuory Building:
Parking Req./Provided
ETLECTRICAL
� Transformer � 15-50 KW
❑'SO+KW
5-15 KW
§75
Meter Uup to 100 amps
Meter �over 100 amps
Sub Panel
Motors�0.1 HP �7:5-8
InaSolar 09�75 HP �16-15+
Microwave
Pole Light
Range
Sign
Standing Sections
Tresh Compactor
laue Fee
_
h
C� �'
FEES
$ 3
Z
O
N
I
N
G
F
E
Q
M
T
$
DEVELOPMENT SERVICES REQUIREMENTS:
2oning Approved By Date
BuildinB APP�oved By Date
Applimtion lauad By Dat�
SUMMARV OF FEES �
BUILDING PERMIT $ SMIP $
PLAN CHECK $ PERMIT �/J� �
PLUMBING $ �Q ISSUANCE $ .���—
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL $ ' GRADING � S
PLANCHECK 50% $- MICROFILM S
MECHANICAL $ - TOTAL FEE $ �
PLAN CHECK 25k $ �
CONSTRUCTION AND PLANNING
APPROVALS Permit #
1. Temporary Electrical Service or Pole
2. Soil Pipe-Undrgrnd.
3. Electrical Condui[ Utility-Undrgrnd.
4. Electrical Condui[-Undrgrnd.
5. Steel Reinforcement
6. Electrical UFER Grnd.
7: Footings
8. Foundation� '
9. Water Pipe-Undrgrnd.
10. Struc[ural Floor System
1 t. Property Sewer Line & House Connection
12. Sewer Cap
13. Roof Drains
74. Rough Plumbing
15. Rough Electrical-Conduit
i6. RoughElectricWiring
17. Rough Wiring Sign
18. Rough Elearical-T Bar Ceiling
19. Rough Heating & Air Conditioning
20. Rough Factory Fireplace
21. Ducts, in Structure
22. Ducts, Ventilating
23. Gas Pipe-Rough & Test
! 24. Roof Framing
. 25. Roof Sheathing
26. T-Bar Ceiling (Structural) & Monocoat
27. Frame and Flashing
28. Lathing & Siding
29. Insulation
30. Drywall Nailing
31. Plaster Brown Coat
32. Elecvical Power MeterFinal
33. Final Electric
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 pomesticFinal �.
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATEOFOCCUPANCY
No. Date
Date
POOL & SPA
Inspector pppROVALS Permit # Date I
52. Pool & Equipment Location
r.
�.
53. Steel Reinforcement i;
54. Forms �
55. Electrical Bonding
56. Rough Plumbing & Pressure�"fest
57. APPROVAL TO COVER-GGNITE
58. Electrical Conduit-Undrgrn8 _
59. Gas Pipe, O Undrgrnd., Test_•
60. Backwash Lines, P-Trap, O:,Undrgrnd.
61. APPROVAL TO DECK
62. Backwash & Receptor-Final
63. Heater & Vent-Final '
64. Plumbing System � Final
65. Electrical-Final
66. Solar System-Final
67. Fencing & Access Approval �
68. APPROVED FOR PLASTERING
69. POOL/SPASYSTEMSFINAL
FIREDEPT.REQUIREMENT
APPROVALS Permit #
70. Underground Hydro
71. Product Piping OGas OOiI
72. Underground Flush
73. Undergrnd. Storage Tank O Gas ❑ Oil
74. Overhead Hydro
75. Dry Chemical
76. Dry Standpipe
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION
80. FOOD CERTIFICATE ISSUED
Notes:
L ED
ti
AP. No. LOT 1% TRACT
GROUP Z °� J TYPE
INSPECTIONS
Final Gas
PARK N0. �
ceton Drive
FIRE ZO
ZONE
DATE
R1
SUBCONTRACTOR
�
DATE 9-26-5%
BUILDING PERMIT NO.
VALUE $ 12��t00,00
NORK R05. W�Btt.
DATE I, VNUMBER
. � S'�32
COSTA MESA BUILDING DEPARTMENT
P.O. BOX 31�
� COSTA MESA. CALIFORNIA
FOR APPLICANT TO FILL IN
�.u_-i rnin�cai�.irv ��niv�.
COSTA MESA. CALIFORNIA
MAIL
ADORE55
ciTv S n
ARCHITECT
OR ENGINE
ADDRE55
IEGwL
DESCRIPTION
A.P. NO.
SIZE
OF l
E%ISTING 6L[JG.
SETBPCN LINE FHOM
CENTER OF STREET
�IF. TNo:Kl.�iS
uc.
NO.
ITV LIC. I��/.�'
� NO. �(
TEL. �
NO.
BLOCK TftACT �
NO.OF BLOGS.
�IOW ON LOT
REAR YARD G(J
DESCRIPTION OF WORK
NEW �' A�TERATION AODITION
REPAIR � �I MOVING DEMOLISH
SREDING IC�I� ROOMS STORIES
i 4
EXTERIOR WALL ROOF •
COVERING COVERING
FEE RECEfVED
SEP 13 1957
FINANCE DEPT.
CITY OF COSTA PAESA
APPLICATION FOR PERMIT
BUILDING
FOR OFFICE USE ONLY
iveo ev
oA1E issueo
�
COSTA MESA. CALIFORNIA ,
FIRE
ZONE
APPROVED
BV
CORRECTIONS
ST/.TE THAT THE ABOVE IS CORRECT 4NO TGREE TO COMPLY WITX 4LL
CITY OROINiNCE$ /�NO ST4TE L<WS REGULRTING BVIIOING CONSTRUC�
noru. VALUATION
SIGNATURE CO EG E PAR K NO. LL
PERMITTE
�,�, „ ��/ �/I /1 i1 �s'v o ,, $ I 2 , �} 0 0 .
PERMIT FEE S �O ^
PLAN CHECK S /`{ ^
TOTAL FEE S �`( veMr