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APPROVED
CITY C)F COSTA MESA
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 917 C08TA M68A. CALIFORNIA
For Applicanf to Fill In Complefely
TYPE OR PRINT
eui�oiNc � �J�
ennorav �n��% FII I Mf1RF WAV
■ ARGHITECT
COS7A MESA. CALIFORNIA
ENNETH W. KOLL
BEACH
� E RECElVED
JAN 111962
FlNANGE DEPT.
��TY OF COSTA MESA
APPLICA ON FOR PERMIT
BUILDING
For Office Use Only
ftECE1PT NO. P¢qMiS N4
BUILDING
ADDRE6S
COSTA MESA. CALIFORNIA
_____'_'_____'__________'_'___'�FIRE
6TA7E /.�.��
LIC. NO. V
BIZE
OP LOT � �O �
U8E OF
E%ISTING BLDG.
68TBACK LIN9.6ROM
■ USE
No: MI 6-322�
� I NO. OP BILGB.
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I LEFf � � I RIGHi
DESCRIPTION OF WORK
I X �� e, r�oer,,,u � �� .��,r,,.
ROOF
;p COVERI�
qND WORK TO BE
ZONING
ZONE NO.OF U88 OP N6W rj/�n
R 3 I PUNB Z BIIILDINO W/�-
e A�e���,,.. Lr.7`' ! 9 TiP �I z 8!
' (CHMBR LINH 9TJ
FRONT
' 30
R.SIDE
REAR � r �'
APPROVED . /�
BY «��
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6 �N.
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1 XHRE�Y ACKNOWLEDOE THAT I X�VE REAO TM�9 APPLIGTION THE AMOUNT BHOWN UNOER VALUATION IB VOR TX¢
AND eTwT¢ THAi TH& ABOVE IB CORPEGT AND AOREE TO COM-
PURP088 OF E9TAHL18HIN0 /� PEPMIT FE6 ONLY.
PLY WITH ALL GIT'f ORDINANCB6 AND BTATE LAW9 REGULATINa
eultutNa ConsrnucT�oN. VALUATION
81GNATURE OF /� PERMIT FEE $ ��
PERMITfE � � $ �L/ I[�� ` y C
✓ PLAN CMECK $ :�L 7 �
AUTFIORIZEO AGENY y G
TOTAL FEE �•-