HomeMy WebLinkAbout3122 COUNTRY CLUB DR - Building PermitswonEssaem�w�c: g122 CUUNTkY CLUB llR
OWNERSNMIEIFIQq'M�l SCOTT, CARMEN
AD°"�u 3122 COUNTAY CLUB DR
COSTA MESA,CA 92626
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coxm�crarsruxE: NOCK PLUMBING ( 714 ) 895-1246
CQRNICTORSMNN1011612 KNOTT ST
���+Eu GARDEN GROVE CA �� 7077'75
92841 uNT: 1'7
LICENSED COMF�CTOflS DECLAPITION: I MreEy ell'rm urcbr penetly M Po�ury ihel I em IicenaeE under provieiona of Chepter 9
(cammend�p with Seclian ]000) a�� 3 d Ne Buvr�eae eM Pmleeeiom Code. eM mY lioenae u in lull Mcs vd eNep.
c No.:050386 uc.cuss:C,_36 uc.�No.: 70r7J�75 EXP; 02/98
me: " commew: 1 ] w
Y�.�� I
OW BUIL�Efl DECLAFRTION: I hereby elfimi uMx prie�y d peryury �hel 1 em e�emq Imn �M Convwfas Liroiue lew ta tha
xig eeeeon (Setlion ]0�1.5 &niwss eed PMeasions COCe: Any eIy ar munty wfiieh rpuiree e pe�mit to eonshuel, ellm, impraro,
'md'sh, or repek eny sVuewra, peior �o na vauenee, ebo reQuiies IM epplirenl lor euch pmnG b fib e egmd stelemen� Net M a eM
censed W�1 to IM prwivwu G �ha Conlredwe licema Lew IChepter 91�mmtiiq xilh Setlon ]OW) d Divebn 3 d iM
.eirwn eM Prdesaions Code� or Ihel M or eha ie examq thareivn end iM bvia lw Na dleped esemption. My violalion of Sepion
)aJ1.5 by env eaWirani 1« a pmmil wbjade iM epqicem b a tivil penelry d na maa ihan IMe huMred ddbn �Ssoo11. .
� I.eso�merW�MpopanYamY�WoY�+�hwegmav�haieabcompansation.xilldotMwak,eMNenncWreura�intended
or ofleredM sab (Seciion ]016. Buwnme vM PrWesaiona Code: The CoMreclore License Law does rwl appy lo en oxTm ot qoperry
who builds or imv� �hereon, uM wM daee such xak Mmxl! a Mrwr «thraqh h'v or her own empiqses, povided thet wch
improvemmU era nd imeMed « WereE ta eab. H. however, iM WiNirq a'unqavement u sold wi�hin ar yeer d mmpinon, the
wrnrbuikbr will M1eve the buken W provirp M or eha did rwt build or impow /a Ihe purywe d mle).
� 1. as owner d the propeM. � exduarvely mntrenm9'�+�h IicrosaE contrec�on ro cw�ua the v�q� (�� ��. �++irme erd
v�ai��o� coae: ma comree� u�� �.. ma. �a �wr �o .� o�„�« a wwanr ,•ne w�a. « ��+.e m„� �e wno
convecta Ior wM Drol�s �h e mmretla(e) IicenseE Wnuenl lo iM Conveaon liceme lew).
� lam emmq uMerSection: B.S P.C.,forihie reeaon:
Dete: Ov.+iar:
1 do hereby cerliy Itu� I em ewere d ard uMxaiad Me rWui�amerua W Callwnie Maellh eM Sdety Gode Seqiane 25505.2553�, arM
2553G, eM ihet I or eny tNuro buikinp oavpenl will I wil nM (dreb one) meE lo wmply wYh eeid stete mEea eM iM �eQuiremenh br
eV��ImcarevunionamotlificetionhaniheA"r u�i v�epameniDixrid.Revde��elmimlueunePD�ianenaxemWlromtMae
aa;�.
ome: nodc.m:
W OflKEq'S COMPQ151TION UECLAN�TION: I hereby elfiem uMx pmNy d pajW one d Ihe Idbxi�p dederaliom:
� I heve end vril manten e<ertAicme d mnsanl to eeH.imun br xakeia' compenxtion. m povNetl Iv Ey Setlbn 3)00 d iM Labar
coao. �n �ne wnonw,ce a Na woni �« wlvA, �nia ro�n ie ie.uae.
❑ i n� �a �;i �m.:� .,on�� �v�� ��,re��. � rea��ree er saa�oo aiao a ma �no� coea. ro� ma ae�ro�� a me
}t wwk la whirA �his peimn is iaued. MY wakere' wmpenaelbn ineurar�ca wr'ier eM pol'ry number ars:
c�.: GOLDEN EAGLE EXPIRES
PdiryNumbec NW(' a'�y�iaac'�- 09/01/98
.,is nnaim neee �ar be �deroe i me c�+� �s m. �s n��d�d dar�. �Siool m ress.�
❑ i�nM uw m ina c«ior�� d n»..on� i« ..nrn m�. w�n �a �.�aa, i �wi �a amdw �v a� m�n m��a .o e. �o
become aubjeU to �he xvrkera' compematim lewe d Celil«nie. eiM eprea IMI il 1 ehauM Exmie eubjetl to tha Mpknn'
��om�.,nay w� �� aoo a me �nw cme. i�i i� we v�wm�.
D : � Applicent:
amlrp: Fellun M �xuro worksr�'rompsiueHon coveraps Is unl�wlu( mO�IWI �ub/ect en smp/oyer ro a/Miul pruMa me
c/v/I flnu �q ro ms hinOrM fhouurM Jv/kn (f100,OW), M etl!ltlon b!M cw! ol rompen�sUOR Oa�W e� provWsd br In
Sxtlon J)O6 0l M� laDor COM, Infersat, �ib efrornsy i/ws.
CONSTNUCiION LENqNO AOENCY: I hereby eHi�m uMx penel�y M perjury ihe� thare ie e connivaion kidirp eqezy la �M
oano�e�� d ma wur� ror wn�d, mm w�� m ewed Iseaon x�. cw. cl.
LENOEN'S NAME:
LENUER'S ADDPESS:
I eenity thet I hare roaE I�is epplcmion eiM pme ihel �M eEwe inlwmNion ia ewrad. I epree �o mmply xnh dl oryeed oounry rcEinenro�
aM stale kvn reblip �o Wildvp con9r�vfion end hereby wthorrte repreeentalrves d Ihia dty b anter upon iM eCwe-meMionetl qopeM
��� ��90���� °��P��9 RON NOCK
/r
�
(S151d6.W P) M/Ane-Build�q d Sdery: G�eemFb: Cenery-Applicant; Pink-Aeran�e; (3olden�ob Aaesaa
CITY C1F' COS'fA MESA - BUILDING PERMIT
PERMIT NO: P 086775 PLAN CHECK NO: N
CONSTRUCTION TYPE: V-N PERMIT TYPE: PLU
JOB DESCRIPTION ; INSTALL DISHWASHER
CLAIM VALUE: CALC-VALUE:
Pq�- oo �
f�ERM NO: P 086"775
GOVT: N SUPP: N
PURPOSE: OTH
SQ FT:
GROUP OCC: R-3 /
COMMENTS: NO OTHER WORK ASSOCIATED WITH'THIS PERMIT
�iri�*xx*****�ri��x�r*��r�e*�r�e;�i�**�r*i���rx��r�r�r*��*�*�r*�r�*�r*��r�*���**********�**�**�r***��*
Z O N I N G R E.Q U I R E M E N T S
S E T H A C K S
------------ MAIN HUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
3£�: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ: PROV: PARCEL: 13912312 ZNE; REF NO:
PLANNING NOTES>
� �
�F 1F �1f iE �E if iFlE iE 3E iE iE iE if if !E �k if i! 3t jE 1t it if 3E iE iE jE iE iE 1E dE jk �E 1E fF �E 1E fE �E iE fE iE iE iE iF iE,iE ik iE iE if *# if �)E if 3E i(� iF iE iE1t if iE dE iF iE jE iE iE iE if aE iE dE iE iE iE
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
+Y_�
ZONING APPROC�ED bY .
bUILDING APPROVED BY :
LEGALIZATION:N
F E E S U M M Aii Y
BLDG PMT FLUMBING ELECTRIC MECHANIC
DATE:
DATE:
DATE:
iFiFiFiE iE 3f ik if ak if iE'IF iE iE �
STRUCTURA SEGMENT:N
FIRE SMIP/RES GRADING
PERMIT 8.75
253 � SMIP/NON-RES
PLAN
ISSUE FEE 22 , 00 ;.�,
BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
TOTALS---> 8•. 75 22.00 .:. 0. 00 30.75 30. %5 , 00
�J
REVENUE DIVISIUN TOTALS--> COLLECTED: 30.75 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECR
30.75 �
�E �E 3E iE iE iE iE �E iF 1F iE iE iE �)f -%3E �Jf aE if jF 3E iE # iE # 3E iE jE 3E iE it iE iF jt it ** 3f �1E iE 3E iE jE ik it 3k �3E aE �7' it i4 iE �E iE iE it 3E 3E �1k 3E 3f 3E �E �E iE �Y.-it �E �lt �lf �E jE 3f �E if �E 3E 3E �
I N D I V 2 D U A L•� F E E B R E A K D O W N
T QTY D E S C R I P T I O;N UNIT COST TOTAL COST
'/ �
PLU 1 LIISHWASHER � 8.75 �.75
END OF FEES
1
��
r'
82-82-1998/89:14 AN/f38,75
RCPTY:81-8014870
PERMIT:086775
�
CONSTRUCTION ANDPLANNING � ' - . ". POO 3PA
APPROVALS Permit# Date Inspector .qppROVALS Permit# �ate Inspector
t. Tempo�ary £lectricai Service or PoVe � 52. Poot & Equlpme�t Locatiori .
2. Soil Pipe�Undrgrnd. � - :.1 53. Steel Reinforcement - . . - ,
3.� ElectriCal Conduit Utility-Undrg�d. � � - . 54. Forms - � � ' �`
4. Electrica� Conduit-Undrgr.nd. � , 55. EleCtricat Bonding � �
� 5. Steel ReinSorceme�t �56. Rou9h Plumbing & PressUre Test . f
6. Electrical UFER Grnd. 57. APPROVAL TO CQVER�GUNITE �
7. Footings � �5&. Electrical Conduit-Undrgrnd.
8., FoundOtion . � 59. Gas Pipe, � Undryrnd., Test . � ,!'� '
9: Water PiPe-Undrgrnd. - ,��, - , 60. Backwash lines, P-Trap, 0 Undrgrnd. ' �
' 10. Structural Ploor System � � � - � 61. APPROVAL TO DECK 4- ��- 1
; 17. PropertY Sewer �ine & House Conhection� �. , 62. Backwash & ReceotorFinal•� � �
12. Sower Cap � �. '., - . . - �63. Heater & Vent-Final - � -
13. Roof Drains - � ' . > . � 64: Plumbing System � Final ( . ,
14. flough Plumbing � I' �� � 65. Electrica6Final j � l •
75. Fough Electrical•Conduit ' �� , � _ � 66. Solar System-Pinai •� � . . -
16. Rough Electric Wiring � � �67. Fencing & Access ApProval ' �,
t7. Rough Wiring Sign . I=' ' _ : � 68. APPRpVED, FQR PLAS7ER�,ING � ��
18. Rough Electrical�T Bar Ceiling ��" � 69. POOUSPA SYSTEMS FINAI
19. Rough Heaxing & Air Conditioning � FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace _ APPROVALS ,� Permit #
21. Ducts; �n Structure 70. Underground Hydro
22. Ducts, Ventilating _ � . 71. Product Piping �Gas OOiI
23. Gas Pipe-Rough & Test 72. Underground Flush �
24. Roof Framtng • � , 73. Undergrnd.Stora9eTank OGas ❑Oii
25. Roof Sheathing " . � • 74. Overhead Hydro
26. 7-Bar Ceiling IStructural) & Monocoat � - 75: Dry Chemical � - � �
27. Frame and Flashing, . 76. Ory Standpipe y � , �
28. Lathing &•Siding ' �- ' 77. FIXED SYSTEM FINAI. �
29. Insulat�on � 78: FIRE PREV. FINA� '
30. Orywail Nailing � HEALTH DEP7. REQUIREMEN7
. 37. Plaster Brown Coat. . 79. FINAL INSPECTION .
32. Electrical�Power Meter�Final � 80. FOOD CERTIFICATE ISSUED'
33. Final Etectric � . , Notes:/�_g,_q$ � �/���1z� � �_ �
34. Finai Neatin9 & Air Conditioning . �
35. Final Gas Pipe-Test . • ' " , ' -
36. Hood or Canopy . . ' •
. 37. Final Factory Fireplace � : ' . � � . .
38. Final Plumbing . �g'q$ N., ' -
39. Water 5ervice�Finai - � � _ ,
40. Gas Service-Final � � � . . '
41. Solar �omestic-Finai
42. Backflow Preventer �
43. Backflow Irrigation � � '
44. Landscape Irriqation System � � . �
45. Sound Attenuation .. � , L� �-'
46. Handicap Regulations. - • `�� .^
47. FINALSTRUCTURE & BUILDING • '
w
�:x �
e: n
48. FINALPLANNING � , • ':a:.T
49. Electric Release to Edison - `;:n
50. Gas Re�ease to Southern California Gas Co - ';;:; �r
� - _ . n
51. CE(iTIFICATE OF OCCUPANCY �
No. Oate
_ . .. - ,: � - � . .. � �.
_ - �'" ,� . � . . - . -
.. . � �. :.. - : - - .
�� � . � � ' � . , . �
�` ' . � � , ,. . � . � � . _ � �' .
; � � - - . . .- -. _ . _ -� �_
- . , ; - ` �,- -�
� � - '� - .. . � �' .,.. _ - . -.
, . . . . ,. -� . - ._ ., �, � . , . . .
. . . . . . . , , . . . . � .
,.. ... .
' ' _ ' June 25, 1973 . . .. . " - .. . , ..'
� , .3 � - . . . �
' _ , _ , . . ' , • ,
. . '. .. 5 . . . . � ' � ' 1 . ' ' ' _ . . . .
.' - , _ i . - `. ' _ " . ' ` . , ' 4 . . 4 . , . — . .. . :: ` . . . .
.
• . , ; . Mr. Walter �Scott ., . " ..'. . .. _ � � _ .
` 3122 Country Cluli'Drive =..'.• "�. � �' ,` .. - . ' .
. �. •Cos[a` Mesa� California;' . 92626�. . ' ' '
Dear �Sir , . �. . �. '
. `� A buildfng permit �h,as�'been issued Co �Irvine Pools to construct �
� a privaEe swimming pool' o our property. • , ,
, * � , z .. ,
� In`order Ehat your pool will b �safe�one�and for the purpose :' •
of advising�you of your responsibility cegarding.the requiremenfs - �
�of tfie�Cos'te,Mesa'Municipal Code; we refer you to'Sec[ion S10Z, a
��PY ;of-which is ' ached ' ; .. � '. " , ' . ,
' .t . , ., ti . . .
` �This letter is direct to you"in ozder [hat you.will be aware of "
_ .„ our,.ordinances-and can make a comple'te�safety check of,your pool� -
; _ area. ' : . ' � ' , . - ; - .. v
, , _ . t= ; � • . ,
: '; . : r, . . ,.� - , : : Sincerely`yours� ' - . . ', •. .,
,,. . ,_, .
... .,_ r:� - .- - . . . -.
,. � .: . ;� . ; �" _ . .
, - . . • . � RICHARD HANHART ' - ,
� ' • ' ,�-Building.5afety.:Director ., ,
RH:cD' ., .- 'r :
.4' . ' � . *� . � �'. a� .. . .
' ' . . . , . . � . � �' . "
� . 4. . - ^ ` . � � ' ' . • . . t
. . ' ' . . - . � . r . . .. . . . .
- . .. ' !. . . _ ' . . .
. . t • . � . - • •• l. r. . ' . . . � _ -
, � y
=�. � sA
r �� ��
: ���� .02
TESTING
July 16, 1973
Laboratories �f ���ut��Z.= e�Zc�foz,�«=, �,u.
P.O. BOX 4] . 3310 AIRPORi WAY . LOfd6 BEACH. CA!IF. 90301 . �?Il� <26�3?>5 . p1?� 53e�2366 . �7N� 878-N32
0cn�iC� OFFlCES:
� i51�Dnw�FHe�o��Se�e.� " rvo�Ja:������.eiavS+g
Sente rne, Cdlia,nla eTo1 f.,^.��'^.', ]�55 a.aveo n�... °O. Bo. n .
�)!�� 5]1.}0�5 �� I„ p, � �ary Peecn, CeltC OpBY �]U� L)6�13A6
3
���fl. :
.*�r :
Examination: $CJ3-�b39
COMPRESSION TESTS ON GUNITE CYLINDERS
• � Mr. Erro1 F. Heesch
. 12921 Aspernvood Lane
Garden Grove, Californla 92640
' PRO�ECT Swtmming Pool for WALTER SCOTT
ADORESS 3122 Country Club,, Costa Mesa
SAMPLE FROM Gunite Swirtuning POO�
•MCMRER
ENGINfFG
MIX
DATE CAST
DATE TESTED
CYLINDER NO.
COMPRESSION
TOTAL IOAD, LBS.
POUNDS PER SQ. IN.
4-1/2 to 1
7-9-73
]'�D-%3
I
7-Day
10),$00
3.650
CONiRAQOR
Irvine Pools
SUBCONiRACiOR
Grove Gunite
SPECIFIED
STRENGTH
CYIINDER SIZE
� 7-16-73
II
]-Day
1 12 ,000
3,�ioo
CO MPl1ANCE 7-Day test Gomplies with specif(catTons.
MADE BV pEIrvENEO BY
CYtINDERS �- - - Heesch
o�sT�ieunow: . ,.id�IL'V«' a �]i'11 � i .1 4�. �
E. P. Heesch - 2 .,
Gosta Dtesa Building oePt. JUL l� 1973
,. �
2,000 psi
7-16-73
I11
7-Day
92,000
3,255
RECFIVED OM
7-10-73
IV"HOLD"
V"HOLD"
VI"HOLD"
'�...iP--p�f � L/
.�, v� s.�. + u- �D �c vf CO`.'� 'Jf����l acL�lui. O�- ...�f�.15 •y:..pu�S�i�pn �Oc o�.�. •. ]�. , � ufnOx:s ppvC�45�Orv5 OR tr.
. ��'.5'�ut r ��� a( .vr. ♦� ..(u ..� _SIu�r7 �F^�.. . .. u .�� �E.� �oo.�i).v� �S � r�..V�� � f. .Y C _. ini5 +k. PJO�rC ��OO.eSfLV(5
AD
DATE
I:PL��71.[el9�:a�liriC��
0 1 —12 —12 LOT 10 TRACT 6 FIRE ZONE VALUE
� ,•ECTIONS Si nature Date GROUP TYPE
� � I_ � � % SUBCONTRACTOR
�Pool Location
Fo�ms
Main Drain
Steel Reinforce
Elec. Bond '
Approval to Cover t� ' G
Underground�Electric �� ���
Gas Piping Test
FilteringSystem Lines 7�6
Backwash Lines and Recep.
Electrical Final
' =r and Vent Final
System Final
Backwash and Recep. Final
bing
Y
3b84'
+ � !Ui� 22-73cnsr002619�+ �*��39.50
�� COSTA MESA BUILDING-SAFETY DEPARTMENT
� P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
APPLICATION FOR BUILDING PEFMIT
� ForApplica toFillinCom /ete/y RECEI�{EDBV DATERECEI�o
/�`� D TEISSUE
BUILDI �%1/ �-aa- 3
AODF S / vt ^�q
OWNER . A.P. NO. J/ Z3" ��. PERlg(I /
��
MAIL ADOR SS�j�/
Z . ADORE �. ��� ��
W W EL. BLOCK
a U CITV `'� NO.
Z
Z Q 'CAfW'"TRUCTION � W AO A R P
ON LENDER
am � —
J � BRANCH ' � '
-�N OWNER
� AODRESS � �
. VALU� j;-,.�
ARCHITECT TE . S � �d �
- OR ENGINEER .
' UQ � FI E
, W Q ADDRESS E" TVPE� GFOUP
a W PROVED
W Z CONTRACTOR BV DAT '
JO
mZ - ' � . - � � �
J � ADORESS
W W 20NE NO.OF USE OF NEW
z= CITV NE P�� 2 BUILDING 0(/
F
W � STATE CITY �'AFOS APPROVED VARDS APPROVED
. j O LIC. NO� � � LI0. NO. MAIN BUILDING ACCESSORV BUILDING
SIZE NO.OfiBLDGS. (FROMGLSTflEET) ,
OF LOT NOW ON �OT FP FT. S FT.
USE OF
EXISTING BLOG. F FT.
F SIZE OF NO. OF
Z NEWBLOG. ROOMS STORIES L.SIDE T. aLFT.
U EXTERIOR WALL � ROOF
COVERING COVERING REA FT. FT.
J F BUILDING ANO WORK TO BE PERFORMED DISTANCE BET. BET. MAIN &
' ' ' MAIN BlDGS. ACCFffi. BLOGS.
• -' VAR. # DATE
O � �V� C.U.P.a� APPROVED .
r ' APPROVED ' �S . / /i�� j ..
N C-+
Z
O
UI hereby acknowletlge that 1 have reaA this application antl rtata � � ,
� that ffie above intormation is corract antl agree to comply with .
� all laws re8ulating bviltling consttuction, antl I shell not employ � � �.
F any person in vialaiion of ihe workman's compensation laws of
y the State ot Calitomia. - .� - . ,.� m
b
ZI hereby certity that I am properly licensetl as a contractor untler � SQ. FT.� o
' tha State of�California Business antl Professions Code, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR '
m
Chapter 9, and that-such licenses are in f�ll force antl effect, or I THE PVRPOSE OF ESTABLISHING A PERMIT FEE ONIV: �
am exempt from tl:e prov���iseeeioqqqns of the State of California Business VALUATION /�
antl Profession bcie, Di�3, Chapter 9. �/ �
� � PERMIT FEE $. ul � �� �
]
SIB�atura � � � , s� �j � '`� m
Perml $ q� Y� PLAN CHECK $ ��• f/��' E
� �J �� � o
Authorized Agent LL
. TOTA� FEE $ �
COSTA
100��
MESA BUILDING DEPARTMENT
P. O. BOX 31 ]
COSTA MESA. CALIFORNIA •
,
�:� �t��,Ll��.�
AUG 4 1959
. � i';�' �'; �C ilt;�l.
. . . . .a;�•,
�
FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT
A�DRE55 3122 Country Club Drive BU I LD I N G
COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY
RECEIPT NO� � EN��NO_
OWNER Newport Homes, IilC• � -�-
'- RECEWED BY DnTE RECEIVE� DATE ISSUEO
MAIL �- 3/ s AU6 1 4 195
AooRE55
cirv NeWjJOTt BE$Cl1 TNO. -t� V�3Gz.(. ADDRE�s"s '
ARCHITEcr � ��C. . COSTA MESA. CA�IFORNIA
OR' NEER NO.
. FIRE
AOL ,� � ZONE!�
CONTRACIVh' �� KO�� COnS• NO' _ I ��NElJ ' NO.OF TYpE GROUP
CITY LIC " P�eNS
a �
� TEL. APPROVED
AD�RE55 NO. BY DATE
�E�A� �or 3363 CORRECTIONS
OESCRIP?IOu ryp �'09� � BLOCK TRACT
A-P. NO. � . '
SIZE l[)A,(X\��](1_ MO.OF eLOGS. O
OF LOT dJV /�.+ NOW ON LOT
USE OF
E%ISTING BLDG. �
�E.a.�k ���E FROM �!l 33
ceHTEa oF Slrxeer �/`� REAR VARD �
SIOE YARD RIGHT �V LEFT �`-' '
DESCRIPTION OF WORK
NEW ]{ ALTERATION AOOITION
REPAi.. .MOVING DEMOLISH
BUILDING � Of12C ROOMS � � STORIES
SRE hAS� +�
EXTERIOR WALL ROOF �-
COVERING COVERING
USE OF NEW „r
BUILDING dW 1�
tL
�—_ � �
I MEREBY ACKNOWLE�GE TNAi 1 HnVE RESO tM15 APFIICATION ANO
STFTE TMAT THE A60VE I$ CORRECT /NO AGREE TO COMPLY WITH FLL
CITY ORDINANCES ANp STNTE L/�WS REGULATING BVILOING CONSTRl1C�
norv. , yA W ATI ON
SIGNATURE . / � �� PERMIT FEE $ �. � �
PERMITTE / � � � y . G ��
_ PLAN CHECK $ / / j
�
� TOTAL. FEE 8 .,� ��%
AUTHORIZED AGENT '
�M%