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CITY OF COSTA NFESA
PCANNING-D1V ISt@1�1----
SUBJECT TO BLDG"DEPT. REG.
N�Tti: ADDITIONS, DE ET10N ,
OR CORR6CTIONS S AL B�
APPROVED BY THE PLA [�G b#
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BY: IYI� DATE: ---_ G�-I I�- ��
c�s,3�- �r c�� s��ra� .�o C�r�ll� � 1�-`
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COSTA MESA BUILDING-SAFETY DEPARTMENT FIIVANCE/� yDEPT.
P.O. BOX 317 GOSTA MESA. CALIFORNIA � CITY OF C�/SIA MESA
FOR APPI/CANT TO F/CC /N COMPCETEIY APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
ADD EISS D` � L ' � � �/
COSTA MESA. CALIFORNIA �jOR OFFJCF USF ONLJ
�` . I PECEIPT NO. I P MIT,`N/O.�
OWNER l
MAIL L G�- RECEI ED'BY I D�-��_ES�C� I.- � $185UED .
ADDRE55 ^ �
J '^ �
TEL. BUILDING � -
CITY - NO. ADDRESS
nrxcHl7ECT , ��c. COSTA MESA, CALIFORNIA
OR ENGINEER NO.�
FIRE %� T
ADDRE55 ZONE � T.VPE ✓ � GftOl1P �� v
CONTRAGTO ��,4� OA C NO. APPROVEO �^ � .
e-� BY G%�"1 ( C DATE
AOORESS / C a y,J ZONWG
ZONE NO. OF U8E OF NEW
�ESCli1P�10N I NOTP���� BLOCK TRACT I PLANS �- I BUIL�INQ
A.P. NO. �� D��� BYPROVF.Q. / DATE -�S
�v
SIZE / '�/' I L ` I NOW ON LOT6 �
OF LOT O� ^ �/ REQUSRED ALLOWED
L1SE OF (CENTER LINE ST.)
EXISTING BLDG. FRONT S�/ FT. IN.
SETBACK LINE FROM �O REAR VARO � S.
CENTER OF STREET R. SIDE FT. IN.
/` �% �
SIOEYARD ILEFT �j RIGHT L,SIDE �S/�Ff. IN.
DESCRIPTION OF WORK I�6� -
REAR FT. IN.
NEW I ALTERATION I II �+DOITION I
REPAIR It IIMOVING I IIDEMOLISH I
6UILDING��N,/ ) I � NO�OF �y.�
SIZE /� J b RODMS /V STORIES
EXTERIOR WALL RODF �'l
GOVERING COVERING P//�FL HOLD FOR SPECIAL REO
U UIIDiNG AND WORK TO BE P ORMED
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l�r� �i1'_�'j�'��1�G� --��.�
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I HEREBY hCNNOWLE�GE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE AB E IS CORRECT AND FGFEE TO COM- TH6 FMOUNT SNOWN Ul EN VALIIAT�ON I6 FOR THE
PLY WITH RLL C�TY Op NCE9 /�NO ATE LNW F LATING PURPOSE OF E6TABL1$IING A PEHMIT FEE ONLY.
BUILDING CONSTRUCT N. VALUATION
P RMITTEE OF ~ /���� -_ PERMIT FEE S� 7i
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$ � PLAN CHECK $ /'�� .� ( J
% /.��� -_ J
'AUTHORIZED AGENT _ �,1�' TOTAL FEE $ .� 5'�;5 (/ /
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