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HomeMy WebLinkAbout1936 RAYMOND AVE - Building Permits - 4 _ - - _ -, _ _ Applicant to fill in all spaces except those within heavy border lines and.sign.all appropriate declarations. _ _ _ _ _ - _ _ _ _ • CITY Q.`-COSTA MESA CONSTRUCTION PERMIT PERMIT ���/�j TRACT N0. LOT NO. I - I 1938. RaymondUNIT NO. 1 it 7872 1 !/25/86 5e08`—lL Project Address . : a 7a7J 1 a i Applicant's Mailing Address 10422 Trask Ave. ' TYPE OF CONSTRUCTION ❑ NEW ❑ ADD U''ALTERATION H REPAIR' - ' Owner's Name LameIitOn ❑ CONVERSION ❑ DEMOLISH A p # Phone 6460963 ❑ OTHER t DESCRIPTION OF WR OK/USE OF BLDG. Address 1936 Raymond I - I ! $ Main Building: .Accessary Building: ti 2 ' Arch/Eng. • License No. • TYPE OF PERMIT ❑ GRADING' FOUNDATION ElSTRUCTURAL T Front : O , Address ' ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear , .. . • , r N I Contractor's Name A-Funec' PLnmhing Heatinghone 530-2440 ❑ OTHER - - - --- - - - C Right 1 N PROJECT DESCRIPTION `SQ. FT. OCCUPANCY - G Address(mailing) 10422 Track Atte - K - CONSTRUCTION TYPE VALUATION$ s Left , •- , City License NO. 6664 ' R ,ZONE • ,G RAGING CU.YDS. ACRES "' ' ' ' E ' LICENSED CONTRACTOR DECLARATION ^ Ping. Ref.# ,Parking Req.[Prmate 1 hereby affirm that 1 am licensed untl- •rowsi• of Charter 9 (commencing Remarks: Replace Water Heater ' Planning Notes: 1- {('� 1A /RQLW�• - Q with section 7000) of Division 3 • the rusiness ntl Pr• • '.n Code, and P '! RECtIVFO NOV:2 M l(�� T my license is in full force and effe _ _ _ _. - License clan -36 I 'cense nit II _ _ S ! Date 11-20-86' Signet Ian— - a. PLUMBING .FEES i IMa WORKERS' COMPENSATION 0' LAR' ' Bar Sink Showers - • I hereby affirm that I have a certi ic. e of consent to self-insure ora certificate _ _ • ELECTRICAL • I FEES of Workers' Compensation Insu ance, or a certified copy thereof (Section Backflow Preventer Service Sink - - M3800,• Lab- c.) Automatic Washer Transformer ❑ 15-50 KW Y t. Policy NoI 978832 Company Repub.]." Tndemi Backflow Irrigation , Sewer Cap - - • ❑ 50+ KW J I -• Et Certified copy is hereby furnished. A _ DOnatrUCtl00 Pole Sub. - • -• -.• • Cer(if))'ed cppy,$filed with the city Building Divisj,Q LC d'HCBL Bathtubs Sewer Connection Cooking Unit Meters❑up to 100 amps r ' Date 11-28-Ob Applicant A-ames 7 Ju ing- >_ng - — - '- ' EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers' - Solar Collectors • : , . - - , , Dishwasher -• • ' 'Meter'Dover-100 amps; , • (Thissection need not be completed if the permit is for one hundred ($100)or - - • _- less)., Dishwasher - Solar Piping -Dryers ❑Gas ❑Electric - Sub Panel : - • I certify that in the performance of the work for which this permit is Issued,I - - - : - - shall not employ any person In any manner so as to become subject to the Drinking Fountains Solar Tank _ Fan I •- - ,Motors❑0-1-HP ❑1X-8 :k Workers' Compensation Laws of California. - - ' 1 -- _ k Date Signature Floor Drains' Swimming Pool w/Spa - F;A.U.• - Inc Solar 09-15 HP ❑16:15+ ' NOTICE:If,after making this declaration, you should become-subject to the- - . — - •• • -- -- ' Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks • Urinal ' Fixtures • ' comply with such provisions or this permit shall be deemed revoked- _ MiCroWav¢ • CONSTRUCTION LENDING,AGENCY I Gas Service . Outlets Water Close[ Device Boxes I hereby affirm that there is a construction lending agency for the performance Pole Light of the work for which this permit is issued. (Section. 3097; Civ. C.) Interceptors Water Heater • Lender's Name - p I - • 2 00 Outlets Range I- Lender's Address - - .• - - - Kitchen Sink -- - -- Water Service - - - - -'-' — OWNER BUILDER DECLARATION - _ _• - Switches Sign - , I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash • Garbage Disposal Standing Sections j • following reason (Section 7031.5 Business and Professional Code:Any,city or ' county which requires a permit to construct,alter,improve,demolish or repair - P-Trap Laundry Trays Generator ❑0-5 KW ❑5-15 KW Trash Com actor any structure, prior t0 its issuance, also requires the applicant fo prochspermit p ,- • to file a signed-statement that he/she isaicensed pursuant to the provisions of Roof Drains - f the Contractor's License Law (Chapter 9-(commencing with Section 7000) of - - _- _ _ _^ Division 3 of the-Business and Professions-'Code) or that he/she-'is exempt. -" . . - -� -" - -- - �t -" " therefrom,ann•the basis for the alleged exemption. Any violation of Section • , l ' ' 7031.5 by any applicant for a permit subjects the. applicant to a civil - ' penalty of not more than.five hundred dollars($500). i II - • I / • 0 I, as'owner of thefliropeity or my employees with wages as their sole - Reinspection-Fee V $15 - .Issue Fee $ 3 - - - compensation, will do-the work, and the structure is not intended or offered _ I — Reinspection Fee i I $15, 1Issue Fee I ;,$ 3 ... for. (Section 7044, _Business and Professional Code: The Contractor's i MECHANICAL 'FEES License Law does.not apply to an owner'of a property who builds or improves ' c _ thereon; and who does.such work himself/herself or through his or her own - - F ; - DEVELOPMENT SERVICES REQUIREMENTS: ' employees, provided that such improvements are not intended or offered for Boiler - Hood or Type I El - , sale:If, however,-the building.or improvement is sold within one year of corn- , - - • Canopy ,Type I I 0 Zoning Approved By I Date pletion, the owner will have the burden of proving he/she did not,build or Im- Duct-Under Ground • Building Approved By - ��• ' Date prove for the-purpose of sale). - _ //� ) "/ i��, ❑ I, as owner of,the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System' I _ Application Issued By s.lL,i+ • Date i tractors.to construct the project (Section 7044,Business and Professions Code: - _ - ' . The Contractor's,License Law does.not apply to an owner of property who Duct-Ventilating ❑0-100,000 BTU ❑100,000 BTU " ' SUMMARY OF FEES - 4 , builds or improves thereon,and who contracts for such projects with a con- - • - ' , s. ' ' tractor(s) license pursuant to the Contractor's License Law). lam aware thatBUILDING PERMIT $ �SMIP I -. $ . proof of their'Worker's Compensation insurance should be provided to me.• Exhaust System 0 Multiple 0 System.Repair/Alteration - _ n _ , I - - PLAN CHECK - $ c -PERMIT ❑ am exempt under Section' 'B.& P.C.for this reason • Firepl/Fact.Blt. ICBG# Fire Dampers PLUMBING - $ 'an. ISSUANCE $ Data' - Owner - - _ Heating System& Ducting -. • Registers ' ' PLAN CHECK X25% $ ENERGY P.C: $: _ I hereby certi - e read this application and state that the above- ❑oiloo,000 BTU ❑100.000BTL' " ' 1 -GRADING ' $ ') - ' information - correct:y agre- tor th all city and county ordinances - ELECTRICAL . . $' - •and_state I ' s relatin :to b •ditr retie , and herebyauthorize repro-. — - - - - - - MICROFILM - $ , ' ' •sentative /•f this c'9 o enter - the�.:.ve-mentioed• property for. - - . •, - - -- _ PLAN CHECK 50% _- . • � , s inspectio, pu '® , - - Reinspection Fee $15 - • Issue Fee - $ 3- - PLAN CHECK 25% $ CMF 0865-.6,rev. 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor .71111 • CONSTRUCTION AND PLANNING - . - ' - - POOL&SPA-- - ` APPROVALS Permit# ;Date 'Inspector APPROVALS Permit Date Inspector % 1'. Temporary Electrical Service or Pole , 52. Pool & Equipment Location 1 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement , • 3. Electrical Conduit Utility-Undrgrnd. - • ' 54. `Forms' + . Cu . 4: Electrical Conduit-Undrgrnd. 55. Electrical Bonding - 5. Steel Reinforcement • 56. Rough Plumbing'& Pressure Test ' 6. Electrical UF ER Grnd. • 57. APPROVAL TO COVER-GUNITE • ' 7. Footings - 58. Electrical Conduit-UndrgrnccT: 's 8. Foundation - . - 59. Gas Pipe, 0 Undrgrnd., Test' . • • ' s .. • •r 9. Water Pipe-Undrgrnd. - 60. Backwash Lines, P-Trap, OiCndrgrnd. 10. Structural Floor System61. APPROVAL TO DECK f-- ' ii.,: 11. Property Sewer Line & House Connection 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 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing - 73. Undergrnd.Storage Tank O Gas 0 Oil 25. Roof Sheathing • 74. Overhead Hydro • 26. T-Bar Ceiling (Structural) & Monocoat - 75. Dry Chemical 27. Frame and Flashing - - .r - - 76. Dry Standpipe .` . 28. Lathing & Siding 77. FIXED SYSTEM FINAL . 29. Insulation 78. FIRE PREY. FINAL i 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 . r c 37'. Final Factory Fireplace r ri - 38r Final Plumbing . "/l/PY f . ` • 39. Water Service-Final 4 H - ri_ - . • .40. Gas Service-Final - •"' • ' '41. Solar Domestic-Final • 42. Backflow Preventer 43. Backflow Irrigation • - 0 . ' :44.• Landscape Irrigation System rl 45. Sound Attenuation . -- +'� '' ' 46.i Handicap Regulations • c i,- P• - • 47; FINAL STRUCTURE & BUILDING _ ., 48.,Special Requirements Completed t. '� • • - .- '491 Electric Release to Edison ; r - - • I • L- • •50. Gas Release to Southern California Gas Co . 51: CERTIFICATE OF OCCUPANCY . - ' - • - --- No. • Date - - ORANGE COUNTY BUILDING DEPARTMENT - APPLICATION FOR PERMIT 636 North Broadway ^'� .D - --- - SANTA ANA, CALIFORNIA G . FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY I RECEIPT NO. PERMIT NO.' BUILDING //�5 ��Ay ,.^ d /7 3�S3 5 � �r ADDRESS / r/ /„ IC•/ K/3 OR HOW DIST. /�J° 51,9 4 6_S jf RECEIVED BY DATE RECD. DATE ISSUED OR TOWN (f///y �7 - //�/// > // (/ NEAREST / / 51- j i/ VJ / fly/�n1 ///ils". CROSS ST.//�� ' / /� /� / p / OWNER /Uy /4J � yrR/J'///.//I BUILDING( /7 J , y/`�•y o ADDRESS • / c Giem.AJ7•-/ MAIL /7y .Roc e/ESteR it SCHOOL IIST. I OR ADDRESS / �]� CITY Co s it-61 pie /T TEL NO 13E1/J ] NEAREST i f J CONE"T.iN 11/9--In ).J A ARCHITECT OR LIC. ZONE- 1 NO. OF t I-1 T=IP, I GROUP` ❑1 ENGINEER NO. R I i PLANS /J fJ/ ADDRESS ///- APPROVEDi .(� JA E CONTRACTOR 3 A m NO/,A.Ali BY) L L / ///O'n iTE�1� i 1 co; ' ECTIONS / ADDRESS - - _ - - -- - - LEGAL DESCRIPTION I NOT//d/ZI BLOCK I TRACT I -!� I (ATTACH METES & BOOUNDS):/ ' - NO.OF SIZE OF LOT/ /, PO I NOW ON LOTS O _- -- - - -1 • i USE OF - NO. OF NO. OF _ I -- I EXISTING BLDG. I FAMILIES I ROOMS • - l4 SETBACK LINE FROM: // REAR YARD N24 t I _ CENTER OF STREET �J SIOE YARD ,3-1. ' - - ;p'. ' DESCRIPTION OF WORK 0 O NEW I X ALTERATION I I ADDITIONZ ..1' " D REPAIR I I MOVING n I DEMOLISH I `, 1,g - r SIZE ILDINGn� y / 3 NO. OFROOMS O STORIESn //- V �� Nt..,' sir- Q C L- of Y, �v CO ERING(WALL Cl��C C I EF foci\ - J� "�\ C { Lit CUSE OF OVERING �t ,,/ �/ O ) i J�.� �`T BUILDING NEW V NF �/' Y ✓ ' 4/t� •`:z� t• ~gc `.1U `A /IVA 0 ` �f ‘",Pe i� ;� 'rte ;, 3 64 I t PPROYALS ,r FOUNDATIONjLOCATI \rtCINSPECTORt DATE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS FORMS. MATERIA `-� 0i1J • > '� s . UNDER-PINNING TK w� /�� /� APPLICATION AND STATE THAT THE ABOVE IS CORRECT r FRAME: FIRE STOPS, nn AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES BRACING, BOLTS y wo /„z S/ Ci AND STATE L REGULATING BUILDING CONSTRUCTION. LATH. INT. /2147/2 // 7 f IF -SIGNATURE OF LATH, EXT. PERMITTEE PLASTER, INT. AUTHORIZED ACT. PLASTER, EXT. CC PERMIT FEE $ MASONRY REINFORCED VALUATION $/.3O(JJS0- PLAN CHECK $ ✓- BOND BEAM , 1 0 TOTAL ��NAL ?,W i2 '3 ` 'Z3 L FEE $3 S z _ W ' J • rC _ ` o '\., 1', 1. *1.'•' ,,/S ti. \ ' .• �^`! fi .,\1 \•\ rl ..."0 N.1\,/ .VI L C\• `,\4�\\ r < ! r ' • r, ,..5.00 - r "NOV 4 =53 c \�-- `:: X1 '1 ;;, ,t ;� , A - 0;0 lit- BAUD. "} r -Cs.',, `.\ ,5I.'. > • STREET - - - c•L, - - _-_ lr PLOT PLAN - ! "__ _ Show location and distances from - property line and between buildings. fieltj SW /ZS ' ff /7 3: - . i r 1 Ire ~ - -" _ . . OWNER T,AMERTON, AUBREY DATE 12-7-70 (� JOB ADDRESS 1936 Raymond Avenue BUILDING PERMIT NO. 32544 \ GENERAL CONTRACTOR Standard American Bldrs DESCRIPTION of WORK Extend Bedroom in Residence APN0. 118-212-11 LOT(por)11&12TRACT 499 FIRE ZONE VALUE $ 1,680.00 INSPECTIONS Signature Date GROUP j TYPE V ZONE q_� '�f' SOIL SUBCONTRACTOR PERMITS ISSQED ( GAS Date Number I Signature WATER Plumbing ROUGH PLUMBING PROP. SWR. LINE Q HOUSE CON. H SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND ❑ POWER ROUGH WIRING (''?/ Heating and Vent. TRENCHES FORMS STEEL REINF. ❑ FLOOR SYSTEM BOND BEAM STEEL REINFORCE fl (� SHEATHING j'7.G-(v� /233 o--, L { ib FRAME NO IN [At4 fj LATHING OUT PLASTER, BROW,INNtCOOAT STRUCTURAL, FINAL 1//, ./� -EI }ri ��J -/[� HEATING, VENT., REFRIG. AND A.C., FINAL / ��11� p' a1�'",� PLUMBING, FINAL AND GAS TEST n (/ / ELECTRIC, FINAL 2 -3- 71 �. BUILDING, FINAL j� 1-2'-'-7f 32544 PAID CNSA410* ****_ ?' DEC X0-00 75.50 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely � RECEEIIV//ED/By GATE RECEIVEDV� DATE ISSUED BUIADDRESS Rya✓b RNhibt `-•VTC ✓ C diA /�-7'."!4' 2 - 7- ,1) ..� PERMIT NO. OWNER E T.41. L, L - I A.P. NO. - - BUILDINGMAIL �J ,O/� Z ADDRESS � � - - ADDRESS /[s1 `S3 d `FY oleo // `Lf W W TEL. d CITY NO. / TRACT s/f9 LOT /.2._ BLOCK Z Z CONSTRUCTION NEW ADD ALTER REPAIR MOVING DEMOLISH O N LENDER k 0- m `' /^/ �^ J cn BRANCH OWNER &' '�� 01/29,..,..„,,,,x„ < W ADDRESS' /����///, m•CO ARCHITECT TEL. US El'�Y/!X VALUE /�A dl J < OR ENGINEER NO. (' // O Q FIRE W CC ADDRESS ZONE TYPE GROUP it APPROVED W Z CONTRACTOR S�b1J��QbAyE1 \ti 1l ;/ , / DATE/L-7 4 Om - --- - Z JCC ADDRESS `4C LI. &tom'1tE Ic'iµ � € LS. IO. W W TEL. ZON NO.OF USE OF NE �j�'�Y/ fg�✓l� O= CITY A •1�l A►-FEIu NO.4"3Jd PLANS BUILDING AIArt Z 1- WO STATE �y � CITY /� r' YARDS APPROVED YARDS APPROVED CO CC LIC.NO. .- S 4LOzj LIC. NO. j94i _ MAIN BUILDING ACCESSORY BUILDING 7 O / (FROM C/L STIWT) P SIZE NO.OF BLDGS. OF LOT '' I NOW ON LOT FRONT�,Il/ .../6j./ FT. USE OF 9 EXISTING BLDG. R.SLOE / / FT. FT. H SIZE OF NO.OF 2 NEW BLDG. /2 X 16 ROOMS i STORIES ' L.SIDE FT. FT. _ Q EXTERIOR WALL ROOF BUIL."[ LA P `/'f C._) COVERING CoCOVERING COO/post tsu L, REAR uV rT. FT. J USE OF BUILD NG AND WORK TO BE PERFORMEDDISTANCE BET. BET.MAIN& 1 a ' MAIN BLDGS. ACCESS.BLOCS. Q VAR.# DATE O %CO '2r AA �.r ►aS tec-1 G.U.P.# APPROVED I- APPROVED u�(/ � (n _HY ATE 2 O H I hereby acknowledge that I have read this application and state M that,the above information is correct and agree to comply with - _ - --- all laws regulating building construction, and I shall not employ CC H any person in violation of the workman's compensation laws of C/3 the State of California. ../.{ co Z I hereby certify that I am properly licensed as a contractor under /`^ SQ. FT. - a the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR 5 Chapter 9, and that such licensee are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: R am exempt from the provisions of the State of California Business VALUATION �a and Professions Code, Division 3, Chapter 9. 7" 'L'p N PERMIT FEE $/7" yM-,.� i j O 1 m Signature of 11 / 0 PLAN CHECK $ E Permitteei�Q.LL+"L.� - • e $/ /se, Authorized Agent pt��{,� r - G I/ �- u TOTAL FEE $ Th.OWNER RINE ART, MARGARET AND LAMERTON AUBREY DATE 9-b-b5 JOB ADDRESS 1938-1936 Raymond Avenue BUILDING PERMIT NO. 2+�b86 II GENERAL CONTRACTOR Al tlma-KOO1 DESCRIPTION OF WORK Patio Cover AP No. 118-212-11 LOT TRACT FIRE GONE VALUE $ 200.00 INSPECTIONS Signature Date GROUP J TYPE IV ZONE R-1 A SoilPERMITS ISSUED I Gas SUBCONTRACTOR Date I Number ( Signature Water Plumbing Rough Plumbing Prop. Swr. Line 0 House Con. 0 Sprinkling System Miscellaneous Rough Heating and Air Conditioning Temporary Service or Pole Underground 0 Power 0 _ Rough Wiring Heating and Vent. Trenches 0 Forms 0 Steel Reinf. 0 Floor System Bond Beam 0 Steel Reinforce 0 Sheathing Frame and Flashing Lathing — In 0 Out 0 _ Plaster, Brown Coat Structural, Final Electric Heating, Vent., Refrig. and A.C., Final Plumbing, Final and Gas Test 0 Electric, Final Building, Final a.79/D /-?/. /6.. 24686 t TA MESA•CCOSTA MESA BUILDING-SAFETY DEPARTMENT CITY OF C`JS 1 R P.O. BOX 1200 COSTA MESA, CALIFORNIA 92920 SEP 8 1965 For Applicant to Fill in Completely APPLICATION FOR PERMIT a TYPE OR PRINT n1Y ADDRESS // 30 - 3( illym ArV� tQ u 4 L R[cEirt NO. 3E MAY NOA COSTA MESA. CALIFORNIA jy�55/y/�/v' 4.7�YR9 rt: R I Ng-i'.'i4 et Men n �AT�'r - �. OWNER .Q4 RPy G L.oiT e.t fv A. //['J 7* !r-,� ADDRESS S/l^2n -e-_, ADDRRESS l �/ 3$L34 CNYA/IAJA/ FIREs i i CITY C U T to M4 S �-- NO. ZONE GROUP / APPROVED RPbP/.//0 2 / BY' DATE aj OR ENGINEER _7.sy'St J- N GO ADDRESS 3/23 4/ ezz .S�• ONING ZONE//�� NO.OI /) ma or taw 6-11-4021-' ,(� 1 P N/GG I BUILDIN CONTRACTOR ejli.IT.e .. ��u cZ L r L l . /1j.�A J =- ADDRESS L / A. - [ 99toe- 7 Co ‘ ff1// Jf-. �clNFnoN ( /L L eL�C�L // CITY " - /• A.P.NO. ✓ // D -X./,7_, /1 NOTE: NO EAVE OVERHANG SHALL BE LESS THAN STATE �q,.' /: NEL ^7rp—/ z.y ca 30"TO SIDE a REAR P.L LIC.NO. /Y/ Sv NO. / ( T EAVES SIZE I NO.OF 51.005./ ALLOWED (U.B.C.REQUIREMENT) OF LOT NOW ON LAT YARDS APPROVED YARDS APPROVED USE OFJ MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. 4.6,5. (FROMC�/ 8871 SETBACK LINE FROM FRGNT-`��L.TT. / PT. REE CENTER OF STT REAR YARD '/ et SIDE YARD I LEFT RIGHT R.SIDI X FT. FT. - DESCRIPTION OF WORK L SIDQ2 FT.. FT. NEW ALTERATION ADDITION 1,.0 REAR SC) PT. FT. DISTANCE BET. BET.MAIN a REPAIR MOVING DEMOLISH MAIN SLOGS. ACCESS.SLOGS. O,.y. / / VAR.* DATE SIZE .. . .A'/ ( D ROOMS NO.OF / STORIES / C.V.P.# APPROVED EXTERIOR WALL I ROOF COVERING ROOERIN747/"•• AFR2 7 1 Y/ 1Y+c� TB Q/ % USE OAFF UILDINS AND WORK TO BE PERFORMED (y W/ii J-[-- P•j-T,-o (>dv.Pre- to I m SQ.FT. I HEREBY ACKNOWLEDGE THAT.) NAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE O AND STATE THAT THE ABOVS.IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION BUILDING CONSTRU } SIGNATURE OF s '/%/J _ PERMIT FEE $ 3 '� E PERMITTEE /�"L/��e..0 S tyy.i PLAN CHECK S w AUTHORIZED AGENT Kdo J 3 co A—_ -,_�� TOTAL PEE $