HomeMy WebLinkAbout1657 BIMINI PL - Building Permits •
PROJECT ADDRESS: 1657 BIMINI PL'' UNIT: - - - - - - CITY OF COSTA"MESA ' BUILDING PERMIT PERM NO.:. P - —045/18 - •
OWNER'S NAME: RANJAN' GOULD - .. ' - - .. • ' i .: , ..
•
ADDRESS: 1657 BIMINI PL I • PERMIT NO: P , � 045718 • PLAN CHECKNO: - N `GOVT: •.N SUPP.: ''N
COSTA' MESA .. . . . ,
CA 92626 CONSTRUCTION TYPE: 5-N PERMIT TYPE; PLU • a 'PURPOS •
E : • ALT
( /14 ),957 5147 = • "
Aecx/ENDIiant: : REO.NO.: •' JOB 'DESCRIP.TION ' : GAS RE—PIPE : ( 5 FIXTURES )• ' SQ FT e '
ADDRESS:' — - - '' • f ' j.UNIT: - t ' _ ' .-
CLAIM VALUE: CALC—VALUE:• GROUP OCC : R-3. / ,
PERMITTEE•. ADEE PLMB .• & HTG. , INC— ' , ( 213 )'759=9101 - ,
, ADDRESS: 545.7 CRENSHAW BL '. COMMENTS : NO "B" PERMIT—TO REFERENCE. ' • . "
L.A.• CA 90043 *****************************************kE ********* *******ie*** * *****;Eye*****
UCENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section - Z ONING R E• Q . U I ' R E. M E N T S. • "
7000)of Division 3 of the Business.and Professions Code,and my license is in full to• "and eft t. i S E T B A C. K S - • .
cm uc.: 30203 STATE LIC.:2 4 0 1 86 ) a 55:�6
MAIN' BUILDING " - ACCESSORY BUILDING -
Date:,�/7770 Signature. / �� „1-4-•----•'.
"" FRNT: FT IN REAR' FT IN FRNT: FT IN REAR: FT IN: •
WORKERS'COMPENSATION DECLARATION: I hereby affirm t at I have a certificate at consent to self-insure or a certificate of Workers' 1
ompensation s c(T certified copy thereof(Section 3800,Lab.f) LEFT: FT • 'IN RGHT: • FT ' TM. LEFT: 'FT IN RGHT: FT IN '
DUCT NO.: 0��1 8 O`9 EXP.DATE: u S/01/9 O,
, • I
CDMPAxr: STATE FUND ' PARKING REQp• ' , t PROV: : : PARCEL : 13922312 ZNE: REF NO: •
❑ Certified copy is hereby furnished. L•9 Certified copy is ' d 'the cn :uildin. :w.ion. • • ' • PLANN INC - NOTES> . '
Date: �// Z/�� ,Applicant: _ - .-� .�' _ a _.+ _ s ********************************************************3434***************.*****.* r
EXEMPTION FROM WORMERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred 4100)or less). D E V E L O P ,M E N T S E R V""<I C E S; " R E Q U I R E M E N T S •
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 Workers'Compensation Laws of California: - ZONING" APPROVED BY ' - DATE
Dater signature: BUILDING APPROVED .BY t • . DATE:
NOTICE:IL after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor
Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. .e
CONSTRUCTION LENDING AGENCY: hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y : .' - DATE: I- I �V'
which this permit is issued(Section 3097.Civ.CI" ' *****'*******************3 a -* *3434* * iF** 3434^• 3434** *************7f 1F**�****** ,
LENDER: : • I *********************************************** ******iE***********4***********
ADDRESS: . LEGALIZATION;N , •-- FEE •- S' U M M A R V STRUCTURAL SEGMENT : N '
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason ' BLDG PMT ' PLUMBING • ELECTRIC MECHANIC FIRE 'SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: My city of county which requires a permit to construct,alter,improve,demolish,or PERMIT .— -. : • - 2 . 00- - -
repair any structure,prior to its issuance,also requires the applicant for such permit to file'a signed statement that he/she is licensed - 2 5%' ; cM•I P/NON—RES
pursuant to the provisions of the Contractors)State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business �-P L.AN .. '
and Professions Code)or that he/she is exempt therefrom and the basis for the.alleged exemption.My violation of Section 7031.5 by ' • •
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). , ISSUE FEE • 1 . 00
• 'I as owner"of 'the property.or my employees with wages as their sme'compensation;wiu do the work,:'and the ' BUILDING-rDI.V=> ' ; PERMIT' • ISSUE ' PLAN—CHECK TOTAL PAID i DUE
r -7 structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law -TOTAL > 2 • 0 0 3 . 0 0 0 , 0 0 , 0 0 •- 5 . 0 0 . 00 (
- does not apply to an owner of a property who builds or improves thereon,.and who does such work himself/herself or through _ I
his or her own employees,•provided thafsuch improvements are not intended or offered for sale. If, however the building or ' REVENUE .D I VIS ION TOTALS—t> - ' 'COLLECTED: • • 5 .00 OVER/SHORT: . 00 ..
improvement is sold within one year of completion,the owner.will have the burden Df proving he/she did not build orimprove
for the purpose of sale). - . BLDG. PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK •
• - 5 . 00:
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 9044,Business' , '
•❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon • - - •
and who contracts for such projects with a contractor(e)license pursuant to the Contractors'State License Law).)I am aware 1 r!****'**'*'*'*********************************************************************** '
that proof of their Worker's Compensation insurance should be provided tome. I• ND, I V .I D U A L F E E B R E A K D O 14 N' ' ' ' •
❑ am exempt under Section: B.&P.C. • • ,
for this reason: ' _ •
TYPE QTY D E S C R I P T I O N. • ' UNIT' COST TOTAL COST "
Date: Owner: •
PLU 1 ' • GAS RE—PIPE 2 . 00 • 2 . 00 •
I do hereby certify that I am aware of and understand the requirements of Calitomia Health and Safety Code Sections 25505,25533,and ENDOF FEES '
25534 and that I or any future building occupant ll not(circle one)need to comply with said state codes and the requirements fora ."
permit for construction or modification from the Quality Management District.Residential construction applications are exempt from � i
Air •
-I
these provisions. ; ,
Date: Applicant: ' • '
I hereby certify that I have read this application and state that the above information is correct.I agree to c•mply with all city'and county • - ,
ordinances and state laws relating to building construction and he•. a ' -representatives of this city to nter upon the above-mentioned ,—
property for inspection purposes. / + _ . . - 1 .• Y; '
/ fJ- 4
• 01 OoB51748-000;1748 TOW_ �—"^`
Date: /(�,—�pO • Signator. �. _ �i"- � I _—
Drivels License or Social Security a: • , DATE: U1/12/9°--S '-nc.�—"--
164148 White-Buildino:Green—Coda Enforcement:Cenarv-ApplicanC Pink-Revenue:Goldenrod-Assessor - . -t --- - -
CONSTRUCTION AND PLANNING - _JL & SPA
Date - Inspector "" Date - Inspector
, . APPROVALS Permit# - - APPROVALS Permit.#
•
1. Temporary Electrical Service dr:Pole ,-. . 52. Pool & Equipment Location ,
2.- Soil,Pipe-Undrgrnd.. ',`" • - 53. Steel Reinforcement • • •
r_
. 37-Electrical Conduit,Utility-Undrgrnd: ', 54. -Forms , .� .
-'.„4.3.ElettricaI Conduit-Undrgrnd. 55. Electrical Bonding '
--•:57.SteeRReinforcement - x . - 56. Rough Plumbing & Pressure Test
7_6±Elecvical UFER'Grnd. = 57. ;APPROVAL'TO COVER-GUNITE •
'77-Footings a; _.. 58. Electrical Conduit-Undrgrnd. .1
Y
8. Foundation F,_ • 59. Gas Pipe, 0 Undrgrnd., Test '
9. Water Pipe-Undrgind. ; 60. Backwash Lines, P-Trap, ❑ Undrgrnd.
10. Structural Floor System ' ' ''-1 i 61. APPROVAL TO DECK
.
11. Property Sewer:Line & Hoiise'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 I 66. Solar System-Final
16. Rough Electrie;Wiring , 67. Fencing & Access Approval .
' 17. Rough Wiring•Sign - • '� - 68.`-APPROVED Fog PLASTERING '
18. Rough Electrical-T Bar Ceiling •
69. POOL/SPA SYSTEMS FINAL "
-19_Rough Heating & Air Conditioning' - - "` " . FIRE DEPT.,REQUIR,EMENT _,
•
20_''Rough..Factory Fireplace _ c..<Ti 1, - - APPROVALS=..,Permit# : -
21^Ducts,in St uctufe` •' -• `'.7:1 r-:.4..4: •:70. Underground Hydro
[J..: s G:4 r.,�.
22:Ducts,Ventilatingr •,i as c' -s; - ,-,a •::71. Product:Piping Das 6 Oil
23:•Gas'Pipe Rough &Test - r r1 -(314-: i-72. Undergrodnd Flush K
24•..Roof Framing • -7. ;, , :737 Undergrrid.StorageTanktDGas ❑Oil
25. Roof Sheathing r ' v yr C tc>•_ 'y 74t Overhead Hydro- ..
26.`'T-Bar Ceiling (Structural) &=Monocoa[ �; . j' y 75L-Dry Chemical _
27 Frame and Flashing _ • - _ A' 76. Dry Standpipe ' r
28. Lathing-& Siding'. " -c ' s t • '•n �c- : - c. .
�. 77.: FIXED SYSTEM'FINAL }
29. Insulation _.: = c.-- I `{. 1- 78? FIRE PREY. FINAL ' C "
30. Drywall:Nailing•}x ,-„ -, ` ,I ,,,k ..c > t:..-:,,Y, .:-:tHEALTH:DEPT,. REQUIREMENT
_,31. Plaster:Brown Coaf 7 x. , Ili x '-79' FINAL INSPECTION t.
'V x !;
32:Electrical PoweCMeter,�inal ,: ':. i 80` F00D CERTIFICATE ISSUED_ .
-33.=Final Electric -i • • e: ' �,i+ .. -7-- J/ /
_ -, -, i ; Notes:/ 7r, •rD T/ map!- /ro/eri•alp
- 34,.•Feria! Heating & AQP Conditioning `' c _ i + 'if; i c, - :_ x `ljy>�
35.;Final Gas Pipe-Tesc ; f: s :.• .j1 k 7/`7
:136. Hood o:::Canopy 71'73 - '; r V ;I. : .
-:37:.Final Factory Fireplace - '� - ;; iyi
38. Final Plumbing ' _ c•. ' '"
•
.39. Water Service-Final- _ J `';;l ,,,•`
_'40. Gas Service-Final ,i ?t .1:?4; "' �- _ ' I
^.. .- 7h- 1
`41. Solar Domestic-Final- - °> I
42.Backflow Pre venter '' - i • !s < IT _ r. - 1: v .', • .y; I
• :. ,:i ): LJ r 4: :Ti i1 1: E- • , I
43. Backflow Irrigation •,, _ e ti. ; : i-.
='`44. Landscape Irrigation System''^ t= it �= ' ' -' _ •I
n _r M x; ,...7.-4..r. F_ __ :7-,
4-
-45c:Sound-Attenuation .• . -1 • l < . �,
46:-Handicap Regulations '- x z.* ' '? - v0. :J
H s: < .. r ../-*"* a . E ,
� ..
_,47-FINAL STRUCTURE & BUILDING r. ' �'" - " • i
t-, i .,,x r x
487FIN'AL PLANNING I; c ' `'ra i :1 it
/, 14: x ;:. a .i s x c
4.
:'49:"Electric Release to„Edison `' ! " "I
:50:=Gas: CaliforniaGas Co Release to Southern Calt: -'i#. -- • ._ • rt.; i
4. i - ; x w ;: • oc ti,
'-51. CERTIFICATE OF OCCUPANCY ' - .- `, "`-'
1 No. Date
I
•WNER BOHLEN, LOUISE :V. DATE 9-18-78
JOB ADDRESS 1657 Bimini Place BUILDING PERMIT NO. LA733
GENERAL CONTRACTOR kJ,- -:u'_ , - DESCRIPTION of WORK ; . .
•',P No. 139-223_12 LOT 159 TRACT .ik4.87 FIRE ZONE VALUE $300.00 i` INSPECTIONS Signature Date I TYPE GROUP - ZONE R-1
' IL PERMITS ISSUED
SUBCONTRACTOR
AS Number I I
Signature
WATER Plumbing
ROUGH PLUMBING
-
ROP. $WR. LINE ED HOUSE CON. ❑ -
(4 SPRINKLING SYSTEM
IspA I SCEL LANEOUS
ROUGH HEATING AND AIR CONDITIONING •
-
TEMPORARY SERVICE OR POLE
UNDERGROUND ❑ POWER El
ROUGH WIRING '' Heating and Vent.
TRENCHES It FORMS U STEEL RE INF. L- _ ,/,VC '7417/i7
FLOOR SYSTEM .
BOND BEAM El STEEL REINFORCE n
SHEATHING
FRAME AND FLASHING
LATHING — IN in OUT fl
PLASTER. BROWN COAT
-
STRUCTURAL. FINAL Electric'
HEATING, VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINAL AND GAS TEST n
ELECTRIC. FINAL •
BUILDING. FINAL /64/241
0
46 3 3005 -9/'1'8/78. . 555 . IL
• •
STA MESA BUILD SAFETY DEPARTMENT
KII
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 • . 50D5 Qoon4t{67 33 '-
AP LII AT IN FOR,STRUCTURAL FERMI
For Applicant to Fill in Completely — Use Ink Only RECF I 'D ' DATE RECEIVED e. e fdV
BUILDING / di
/AI , e / a �� ��
ADDRESS/ b/, / (� V L/ LC�� a /M��//b�� 111/7�
'OWNER /�/^�O✓✓tno J r:Vc�t� jRD-/(/��L& A.P.NO. I3//-223 -P2' Pri WT
ADDRESS W �� A2654 V 7(O-// �DIDRESS //Q6_7 g/M ow P .
• TEL. TRACT 3 /J7 LOT IS / BLOCK
CITY NO.
CONSTRUCTION /yam NEW ADD ALTER REPAIR MOVING DFMOLISH
LENDER J \ ,/
BRANCH 2.0 1/1.
V 5C LE/I/
OWNER /..'
ADDRESS �J VALUE ,+(� t _
ARCHITECT TEL. _SE S. / ,/s (Q/Q`�(� $ I !/
OR ENGINEER NO.
FIRE
ADDRESS /7 ZONE YPE GROUP
/���y{��[Cn ��L�- 17 �R BY I DATE APPROVE,,
CONTRACTOR �,69F
ADDRESS ZONEA/ IPLANO.OF USE OF NE et-Ill CI�'
TE
CITY NOI. NS Z BUILDING WALL.
►5�+ STATE CITY YARDS APPROVED YARDS APPROVED
C LIC. NO. • LIC.NO. MAIN BUILDING • ACCESSORY BUILDING
W SIZE • iNO.OF BLOCS. (FROM C/L STREET) 9/]
e OF LOT NOW ON LOT FRONT FT. S FT.
USE OF . • '
EXISTING BLDG. B.SIDE FT. O FT. a
HEl Separate permits are required for L.SIDE FT. FT.
electric,plumbing and heating work. • REAR FT. 0 FT. D
FW' USEE.DF BUILDING AND WORK TO B/E-PERFO M/ED DISTANCE BET. BET.MAIN 8.
G ` o.(/s'Ti9'UGj/aci O MAIN BLOCS. ACCESS. BLOCS. j,
VA
' DATE
Q lLOGIc WALL, , r RI4 C URP.# _APPROVED �/ �/ ^
Y •�Y ROVED/i0 el DATE ithyb0
>" l ���111
x •
Lu
0 I hereby acknowledge that I have read this application and state N
(4 that the above information is correct and agree to comply with m
0-1 all laws regulating building construction, and I shall not employ • i
Z any person in violation of the workman's compensation laws of m
Zthe State of California. 7� m
I hereby certify that I am properly licensed as a contractor under / Q"'�"'FT. • N
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR o
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: • e
am exempt from the provisions of the State of California Business VALUATION ` v
PERMIT FEE $ (�
and Professions Co 0, Division 3,Chapter 9. M ✓/ m
�'V PLAN CHECK $ o
Signature of C//J/ �,}-,,{ ------
� LL
Permittee .../...41.-Jii i r/ r/,�1 $ 0'+/ I/ TAX $ SD g
U
TOTAL PAID $ J
Authorized A ent 51)
OWNER fpr p C - DATE 10-2/1-6l
JOB ADDRESS 1657 Bimini Place._. _.. _ BUILDING PERMIT NO. 1.5723
GENERAL CONTRACTOR Owner builder VALUE $ 150 Q0
AP No. 113-573-12 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Block wall
INSPECTIONS Signature DATE GROUP ,J TYPE III ZONE R-1
Soil PERMITS ISSUED
Gas SUBCONTRACTOR DATE NUMBER
Water
Rough Corn. Refrig. 0 Air Cond. 0
Rough Heating
Rough Plumbing
Miscellaneous
Prop.Swr.Line 0 House Con. ❑ St.Swr. 0
Sprinkling System
Construction Pole _
Underground 0 Power
Rough Wiring .
Trenches ❑ Forms ❑ Steel Reinf. ❑ 4/? /Ai ,6fif t 0 k_ o o 7 N q
Floor System
Bond Beam ❑ Steel Reinforce 0
Sheathing
Frame and Flashing
Lathing — In 0 Out 0
Plaster, brown coat
Refrig. ❑ Air Cond. 0 Final _
Heating, Final
Plumbing Fixtures, Final
Final Gas Test
Electric Fixtures, Final _
Building, Final /O—..0 G / ;.T/V/-
OCCUPANCY
FORM BU4-5M - 7-61 15125
15?23
FE RECEIVED
i. OCT24IMI
COTTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT.
P. O. BOX 917 COSTA MESA. CALIFORNIA CITY OF COSTA MESA .
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPEORPRINT �j BUILDING
BUILDING /4 c7 ,3,t, 7', .,, I (/- (
BUILDING
ADDRESS ( V J I
•
COSTA MESA. CALIFORNIA For Office Use Only
�p IV I RECEIPT NO. 7RI.IIT�O�
OWNER C y ������/// 5
MAIL J / r RECEI D BY pA�2�E vim/ /p ny 4)
Ds
ADDRESS '/ S //J77j I'� / / v Pia
CITY dpc/L/ A(Q4 C. NO. BUILDITEL. / / 7 /Y//�
ADORES (> / • !/•�/
ARCHITECT 4 TEL. COSTA MESA. CALIFORNIA
OR ENGINEER et,rN OJ .L„./4 G,NO.
ADDRESS FIRE ZONE
ZONE TYPE CONTRACTOR APPROVED -Q �/ �lBY ( fy} / 6
ADDRESS >LONING ,
ZONE7Q PLANS USE OF NEW /� ] Alt
CITY /yam\/ PLANE I BUILDING `/ /n
STATE TEL. LEGAL r
LIC.NO. NO. DESCRIPTION
•
SIZE lY/ 91 ) NO, OF BLOCS. // _
OF LOT7 ��/\ y �(? NOOW^--ON LOT A.P.NO. ) -. ) -� ///
USE OF
YARDS EVES
EXISTING BLDG. !U -( �,...�C./ APPROVED ALLOWED
SETBACK LINE FROM (CENTER LINE BT.)/
CENTER OP STREET REAR YARD FRONT & 0 FT. 7/-' IN.
SIDE YARD I LEFT I RIGHT R.SIDE 3 FT. • IN.
DESCRIPTIONIOF WORK L.SIDE FT. IN.
NEW I / II ALTERATION I I ADDITION - I REAR FT. IN.
REPAIR I MOVING DEMOLISH BYPROVED / DATE / /
BUILDING NO. OF l /
SIZE ROOMS STORIES
EXTERIOR WALL I ROOF
COVERING - COVERING
USE OF BUILDING AND WORK TO BE PERFORMED
i J / .
Mr
4.{/3r ;C/' 149
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM.
PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION. VALUATION
•SIGNATURE OF I, / \\ PERMIT FEE $al .
PERMITFE Si� \ �'. n
G\
$ J G� PLAN CHECK $
AUTHORIZED AGENT / J I $ /1 re
..�....._.,..,. .,.,,.- TOTAL FEE sG 0
Lis. t4',,-;.._Y i A.:
I '', 1 ®9,i) L.E'i.✓// >?
COSTA MESA BUILDING-SAFETY DEPARTMENT i'sI vL' �Jts T,
CM/;I
P.O.BOX 317 COSTA MESA. CALIFORNIA M 0 Cl- [L3f\
FOR APPLICANT TO FILL IN COMPLETELY APPLICATION FOR PERMIT
E' TYPE OR PRINT BUILDING
BUILDING
ADDRESS 1657 Bimini Place
COSTA MESA, CALIFORNIA EOR OFF/CE USE ONLY
E 17'
OWNER Glenverde Homes,Inc. RECEIPT NO. I 1 UriNO.in
ADDRESSAILBox 6 RECEIVED BY DATE/RR EIV D DATE ISSUED-
5 I /1 9411ftnv , , t
CITY Balboa Island,Cal if. TELOr3-4220 BUILDING
ADDRESS
ARCHITECT LIC. MESA, CALIFORNIA COSTA
OR ENGINEER NO. I/ /J .j /�
FIRE
ADDRESS ZONE TYPE (� GROUP O..e. s 7/'
CONTRACTOR MaCCO Corp. L C NO. 98808 APPROVED DATE U
ADDRESS Box 65,Balboa Island,Calif. , ZONING ]/,�G ' Qd
LEGAL • LOT �J ZONFj_ NO.OF USE OF NEW Y
DESCRIPTION . NO. 159 BLOCK TRACTJ�87 //NI• // PLANS /�/')i� BUILDING �-++/
A.P.NO. APPROVED ��yir vy / ��
BY ` f`_ DATE )\--
SIZE 7000 I NO.OF BLDGS. 0 YARDS I E
OF LOT NOW ON LOT REQUIRED -lar.
USE OF (CENTER LINE ST.) �
EXISTING BLDG. FRONT .., (2 FT. IN.
SETBACK LINE FROM ^,� J
CENTER OF STREET 50 REAR YARD 2T-F R.SIDE C FT. IN.
SIDE YARD I LEFT 5 I RIGHT 5 L.SIDEFT. IN.
DESCRIPTION OF WORK r�J 1
NEW x II ALTERATION II ADDITION REAR y/) FT. T IN.
REPAIR I II MOVING II DEMOLISH J
BUILDING a.6OM
16!11 ,ROS9 STORIES 1
EXTERIOR WALL �4LV ,I ROOF shingle
COVERING st11C CO COVERING
USE OF BUILDING AND WORK TO BE PERFORMED .
TCcP.ji dencn
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
BUILDING CONSTRUCTED . VALUATION
SIGNA��,{,,��TT / �/ /, - PERMIT FEE $
PER ( A' .4 1 .11 W0. 1 - /(O (J �7 ��—
.�i' _ c., $ I ' PLAN CHECK $ ler—
Au7H' �AG TOTAL FEE $ LT l,—
J