HomeMy WebLinkAbout2520 FAIRWAY DR - Building Permits� - ; � � , ', ..
CITY OF COSTA MESA
B!/ILDING DIYISION
F � 77 FAIR DRIVE. COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • vnvw.ci.costa-mesa.ca.0
`? ` FOR INSPECTIONS CALL: (7�4) 754-5626
�`�� PERMIT NUMBER: BC08-00182
PERMIT TYpE: B COMBO
Sub Type: POOLSPA
�os n��Ress: 2520 FAIRWAY DR CM
APN: a3978205 Zoning: , ,
STATUS: ISSUED
DATE ISSUED: 04129/2008
ISSUED BY: CAC
Suite/Unit:
Viciniry: Primary Occ: R3
Const Type: V-B 5Q. FT: 360 Valuation: 535,000.00
SCOPE OF WORK: INGROUND GUNITE POOL. 360 SF. .
1 FAU>100K BTU 7-
1- POOL1
1 SWIM POOL
OWNER: CAVANAUGH, MICHAEL P Atldress: 2520 FAIRWAY DR _ Unit:
Phone: 949-6453903 , . City/SWte/Zip: COSTA MESA, CA .
APPLICANT: BERGEAUL ELLISON � �
Phone: 888-887-6657
CONTRACTOR: BERGE POOLS
Phone: 888-887-6657.
Cell:
ARCHITECT: ' ' -
ENGINEER: �- .
Atldress: 3467 W INDSOR CT
City/Slate/zZip; COSTA MESA, CA �
License No. 717017
Address: 3467 WINDSOR CTUnit:
City/State: COSTA MESA, CA
License No.
License No.
COMBINiATION PERMIT FEE SUMMARY
Building Plan Check: $320.29
Building Fees: $492.75
Electrical Fees: � $73.00
Mechanical Fees: $41.70
Plumbing Fees: $84.25
SMIP Residential: $3.50
SMIP Commercial: $0.00
TOTAL FEES: $1,015.49
"Refor to fee reeeipis for all fces paid for project
Unit: :
ZipCode 92626
PHONE:
PHONE:
NOTICE: The work authorized by Ihis pertnit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28. § 1. 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this pertnit to be considered legal, such vrork must comply with all applicable codes, and all
required inspeetions and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODE/, IMSFECTIONTYPE D� IN_i1�,IR1�5 f�QD�Fj INSYECIIOMTYPE Q1T� INRMIS
1618 Fixed System Final Fire Prevention ZO6 Final Mechanical
1268 Pool Spa Final - 208 Final Plumbing
200 Final Re-Roof 210 Final Electncal
201 Final8lopR/Retaining Wall 212 Final Fire Prevention
202 Final FaCtory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site ��`5�
204 FinalDemplition 250 Fina18uilding�OcCupancy �/�1 !L �
/T
,
WORKERS' COMPENSA710N DECLARA710N: �
I hereby aKrm under penalty o( peryury one of the following dectarations:
❑ I have and will maintain a certifcate of consent to sel(-Insure (or vrorkers'
wmpensation, as provided for by section 3700 of the Labor Code, for the
peAortnance of the work for which this pertni[ is issue0.
❑ I have antl will maintain Morkers' compensal'an insu2�e, as required by
section 3700 of the Labor Cotle, for the peAortr�ance of the work for which lhis
permit is issued. My workers' compensation Insurance cartier and policy
numberare: �
Cartier.
(Tlie sattqn neeEndOe mriplefedl Mepemi a va1<� al me MMM Oo1ars (Tt001 akss.)
Policy Number:
7
CQ� I Certily that in Ihe peRormance of lhe �wrk (or which ihis pertnil is
�issuod, I ahall not employ any person in any manner so as to become subjecl
to the workers' compens � laws o1 Califomia, and agree that if I should
ome rs' compansalion provision of SecCon 3700 of
he aC ' f ' h comply with these prov � r15. ��
%i
�ppkambSlpnaNre --Dair �
WARNING: FAILURE TO SECURE WORKERS' CAMPENSATION CAVER4GE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE CAST OF COMPENSATION, DAMP.GES AS
PROVIDED FOR IN SECTION 3706 OF THE LAB�R CADE, IPfrEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirtn that I am licensed under provisions af Chapter 9(commencing
vnth SecUon 7000) of Division 3 ot the Business and Protessions Coda, and
my license is in full torce and eHect. �._ �
�Li - � CIaSs-#
CwUarloraSip�aWre C�a
CONSTRUCTION LENDING AGENCY:
❑ I hereby affmn that there is a constnlction IerWing agency fw the
partortnance of the v.ork fv vfiich Vris permit i� i4sued. (Sec. 3097, Civil Cotle�.
Lender's Name:
Lendera Adtlress:
Date
OWNER-BUILDER DECLARATIONS:
I hereby affirm lhat under penalty o( perjury itial I am E%EMPT FROM THE
CONTRACTORS LICENSE LAW for lhe following reason (Sec. 7031.5,
BuSiness and Pro(essions Code: Any ciry or county which requires a pertnit to
construct, alter, impmve, demolish, or repa�� any structure, prior to ils
issuanco, also requires t�e applicant for such permit to file a signed statement
Ihal he or she is IicenseE pursuant to Ne p���sions of tha Cont2ctors
LicenSe Law (Chapter 9(CAmmenting with SBL�ion 7000) ol Division 3 ot Ne
Business and Prolessions CoOe) or that he o! she is exempt therefrom and
the basis (or the alleged exemptlon. Any violation of Section 7031.5 by any
applicant for a permit subjecls the appliwnt to a civil penally of not more Nan
frve hundretl dollars (E500).):
❑ I, as owner of Ihe property, or my employees with wages as their sole
compensation, WILL DO THE WORK, antl lhe slruclure is nol intentled or
offered lor sale (Sec. 7044, Business and Profossions Code: The Cantractors
License Law does not appty to an owner of property who builds or improves
thereon, antl who does such work himself or hersell or through his or her ovm
employees, provided ihat such improvements are not intended or ofteretl for
sale. If, however, t�e building or improvement is sold within one year of
completion, the owner•builder will have the buMen of proving lhat he or she
did nol builtl or improve for purpose of sale.).
❑ I, as ovmer of the property, am EXCLUSIVELY CONTRACTING WITH
LJCENSED CONTRACTORS to consWct ttie prqect (Sec. 7044, Business antl
Professions Code: The contractors License Law dces not appy to an owner of
property wha builds w improves thereon, arM wtW ��cts (or such project with
a contractor�s) license pursuant lo the Contractors License Laws.�.
❑ I am exempt under sec. �
Business and Professions Code for ihis reason:
SignaWre Date
]057�46(]/0])
Owner ID verifietl Dy driver's ucen, , Yes ❑ No
Driver's License No. Expires:
Venfication of Ownership by (type of document, i.e. - property lax Dill or deed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
❑ I hereby cenify lhat no eacavation frve (5) w mwe teet in depth inlo vfiich a
person is required to descentl, will be ma0e in conneclion with work authorizetl
by ihis permit, and that no building sWcture, scaffdAing, falsexwk, a tlemdition
or dismantling thereof, will be more Inan thirty-su (36) feet high. (Chap. 32, Grp
2. M 2, Sec. 341, Title 8, Califomia Administrative Code).
❑ As ovmer-builder, I will not employ anyone to tlo work which woultl
require a permil from the Division of Industrial Salery, as noted above, unless
such person has a permil lo do such work from the tlivision.
ApWicanCs Signatwe
Division o( Intlustnal Safety Permit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupant need lo file and
certify a Business Plan for emergency response to release or threatened
release ot a hazardous material7 � Yes ❑ No
(Section 25505 of the Califomia Health and Safety Code requires, with some
exceptions, thal a Business Plan be filed vrith the CosW Mesa Fire
Department by every Dusiness which has at any one Ume during a reported
year a quantity of hazartlous materials equal to or greater lhan a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of wmpressed gas
at slantlard temperature and pressure).
2. Dces or will the applicant or present or future building occupant need to (le
a regisl2tion (orm lor acutely hazardous materialsT ❑ Yes ❑ No
(Section 25533 of Ihe Califomia Health antl Safety Code, wilh some
exceptions, requires regislration with the Costa Mesa Fire DeDartment by
each business which at any one time has on hand a quantity of acutely
hazardous materials equal to or greater than a weighl of 500 pountls, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
temperawre and pressureJ.
3. Does or will ihe applicant or present or (uture building occupant neetl to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑ Yes � No
(Section 25534 of lhe Califomia Health and Safety Cotle provitles that the
CosW Mesa Fire Department may require the preparatlon, certification antl
filing wilh I�e Fire Department of an RMPP by businesses vTich are requiretl
to register acutely hazartlous materials with the Fire Department.
4. If an RMPP is presently required, has Seclion 25534 0( Ihe Califomia
Health and Safely Cotle been fully wmplied with? ❑ Yes ❑ No
5. Does or will the applicant or present or tuture building occupant require lor
tha work which is lhe subject of ihis applicalion a pertnil IOr SUCh fAnStruCtiOn
or modificalion (rom the South Coast Air Quality Manaqement Distritt or from
any other air pollulion control disinct or agency! � Yes ❑ No
(Sectbn 658502 of Ihe Calilomia Govemmenl Code requires Ihat the requested
intormation ba lumished on applications fv non-resiCential building permits).
6. Will any part ot tha facility lo be consuucteC untler this pertnit be within
t0001eet from Ihe ouler boundaries of a school? ❑ Yes ❑ No
(If yes', lhe faciliry must meet the requirement o( Sections 25534 an0 42303
of lhe Cali(omia Heallh an0 Sale[y Cotle�.
L If a pertnit from the South Coast Air Qualiry Management Disirict or olher
air pollution contml dislnct or agency is requiretl for the wvrk which is Ne
subject of this application, have all of t�e Cisclosures prescribed by Califomia
Health antl Safe�y Code Section 42303 been matle? ❑ Yes ❑ No
8. (If 'yes", attach certifiwte ot wmpliance from the appropriate air pollulion
contml officer). .
CERTIFICATE OF COMPLIANCE: I certify that under penalty ol perjury Ihe
information given above is covect. I agree to comply with all state laws and
ciry ordinances regarding Hazartlous Matenals and Emissions.
Sign3Wre
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penally of perjury that I have reatl this application antl state that
the information given is conect. I agree to wmply with all sWte laws and city
ordinances relating lo builtlinq wnstruction, and authorize representatives af
the City of Costa Mesa to enter upon Ne aDovedescribed property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspecGon.
ipn L er pare
ulM1orixeE App6�n1 �
AOD��cant to flll in all
� CIT�'"-11�COSTA MESA. �yS
f'CC]I�iRUCTION PERMIT � � !ES
�i3�7/�7.11'� J_S�
��y'�y���.1-'!�-.,�y'r���{�
f�liiil�iii/LL 7 �.ILL]!�i'/�/�
� . ii
hin heavy borCer Iines anE slqn all app�aprlat0 tlOCla�a�ians.
T CT NO. LOT �—�dLDG. NO.
b her¢by aftlrm thdt I aT IICBn58tl untlar proNslons of Charter 9(COm-
mencing wlth section 7000) of Divlsion 3 of the Buslness and
Protesslons Cotla, antl my Ilcense Is In full forte antl eHect.
�icanse Class Litense No.
Date Si9natura
WORKERS' COMPENSATION DECLARATION
I herlby affirm thal I hava a CerUflwt¢ Of COnsent t0 seH•InsUre Or a
certiTit�ate O/ WOrkerS' Compensation InSurance, or a cGrtllietl copy
thereOt (Section 3800, Lab. C.).
" y No. Company -
:rNfletl topy Is hereCy turNsheO.
L Certlfle0 capy Is 1IIBtl with th¢ City BWltling DlviSiOn.
EXEMPTIOPI FROM WORKERS' COMPENSATION DECLARATION
((This settlon nlBtl nOt be ComplBtGtl if thG permit IS fo� one huntl�etl
lacer��fy thats�n tha performant¢ of the work (or which t�ls permit I5
Issuatl, 1 snall not emPloy any person In any manner so as to eecome
subject to tha Workers Compansatlon Ldwi of Cdlifornla.
Date Sl9nature
NOTICE: If attar making thls tleclaratlon, you shoultl become sub�ect
to [he Workers' Compensatlon provislons of the Labor Cotla, you must
forthwith complY N'Ith suth provlslons or ihis parmit 5hall be tleemetl
�evOkBtl.
CONSTRUCTION LENDING AGENCV
I �ereby afllrm thet lhere Is a<onstructlon Ientling agenty for the per-
forTanCG Of Ih0 wOrk for whlch [hls permit Is I55UeG (SeGtlOn 3097
Clv. CJ. �
l.enCer's Name
`Lentler'S.AOOrMs
OWNER BUILOER DECLARATION ' � �
I hGrBby aHirm t�al I dm exempt irom tne Contractor's License Law lor
Iha followin9�reason (Socilon 7031.5 Business antl ProfeSsiOnz Cotla:
Any city or caunty wnich requlras a permit to coniVuct, al[er,
IlIlplOVB� tlBR10115h O! 18poll dlly S(fUC�UfB� pfIOI t0I[SISSUdlICB. d150lB-
qWres the applicant tor suc� permit.to.flle'a 5lgnetl statement tnat ho"
I5 Iitensetl pursuant,to tna provlsloRs ot the Contrattor's Litense Lavi
IChapter 9(commancing with Settlon �000) .oi Division 3 01 tha
Business antl PrdesSions Cotlel or [hat he I5 ex¢mot Nerelrom ahtl Ihe
' ppuu�n[ �o� a pe�mrt suo�eccs ina appucani w a uvu panairy
� f mora lhan Iive nunaretl tlonars (y500).
[J I, as owner o/ the property, or my emp loyees wlth wages as their
sole cOmpenL]tion, will tlo lh0 wOrk, antl,ihe StruClur815 nOt iplOntl¢tl
LlcanSe Ldw 0005 nol appry [o an ownef �oL a plop
or improvos [hereon, antl who tloes suth work hlmse
Own BTplOyeai, p�ovltletl lhaLsuth ImprovOmen[s ar0
�offeretl lor Sale. Il, howev¢r, the bulltling or Improvor
n ono year of completidn,-the owner will have the bu
he tlitl n0� builtl or Improve for the purpose of�s
owner ol tne propeSiy, am
ontractors to conslrucfthe o�.
to
a
I�%9 3�°�I
TVPE OF�NSTRUCTION
❑ NEW A�D ❑ ALTERATION
❑REPAI0. ❑CONVERSION ❑OEMOLISH
❑ OTHER
DESCRIPTION OF WQRK
A.P. �
ZONE
8702 II/25/81
PLNG. REF. qp
�
265.58 T�
TYPE OF PERMIT ` "" d�{oP���'YL uNE
❑GRADING �FOUNDATION �STRUCTURAL SET vCAftD T; lO'
❑ TENANT�ELECTRICAL J�LUMBING ❑MECHANICA ��IGHT � ��
❑ OTHER REAR VARD (TO P/L) �
PROJECTD SE S'.R(PTION . PKG.SPACEREq. PROVI�ED ��
_"' ""'anii- --- --- -- - - �--�
54. FT. � �� .��
STREET WIOTH �� .PARK FEE S
V ALV ATION��
GRADING CU. VDS.
PLUMBING
BATHTUBS
TOILETS Z
LAVATORIES
KIT. SINKS
SERVICE SINKS
FLOOR SINKS
DRINKING FOUNTAINS
INTERCEPTORS
SWIMMING POOI
WATER SERVICE �.� �
GASSERVICE �
ACRES
PLAN CHECK
SHOWERS
VRINALS
DO V BLE LAV S
DISHWASHERS
SUMPS
FLOOR DRAIN'.
CLARIFIERS
PTRAP
QLTERATION
OUT�ETS
WATER HEARERS�( BTU OUTPUT
SEWER CONNECTION$
SOLA0.TANK COLLECTORS,
SOLAR PIPING SVS.
� ISSVEFEE
MECHANICAL , PLAN CHECK
NEATING SVSTEM 0-300,000 BTV _
AND DUCTING � 100,000 + BTU _
REFRIGERATI�ON 0-100,000 BTU_
SYSTEM 100,000 + BTU �_
LJ I am mcempt unEar Sectlon B. & P. C. lor this _
. . - I ,•�. � , � � , , . � . � BQILiERS _ _yBTV
reason —
Date � --- '/�In�.,^^. �/� �i�%�%�11.0 �� � � SVST.EM REPAIR..ALTERATION
I �erebvicertitvtnat I hav¢ reaC this aooliration na state tnat ri5c a�eve` EXHAVST SVSTEM MU�TIPLE
f¢plesen[ L s ot'[n15 ty ¢nc¢r upon [ dDOvo me/nL/oneO
519natrure �f� / � �i/ /A�'/�/ate ��'2T'�/
Orivers' Litense or 55 � ISSV E FEE
� CMF OB65-46 White-Builtling; �anary-Applicant; Pink-Accounting; Goltlenrotl-Assessor
0
SPECIFL CONDITIONS:
ELECTRICAL PLAN CHECK
'�"' 0-1 KW_ 1-10 KW _
TRANSFORMER
APPLIANCE 30-50 KW_50 + KW _
MOTOR$ p-1 HP_IQO HP _
(INC. SOLAR) '30•SO HP 50 + HP _
FIXTVRES OVTLETS . SWITCHES
GAS TUBE SIGfVS ' � '
POLE LIGHTS
PANELS MAIN SVB
SER V ICE AMP
ISSVE FEE
'LICATION
$UMMAROV OF FEES ��—
BUILDING !f/..
PERMIT y_LT�/ S SMIP E
PLANCMECK S� 7ERMIT
PLVMBING $ pp �SSUANCE S
GRADING 8
`PL'AN;QHEGyt E `
ELECTRICAL E •31� $
PLAN CHECK 5 MIGROFILM 5
TOTAL FEE E
MECHANICAL S
PLAN CHECK § LE55 AD-
VANCEPC E_
FINAL FEE S
. . - � M. Cavanaugh, Co.
2620 FA�RWAY DRIVE. COSTA MESA, CA 92827 -- TEL
PERMIT /1 G- 1852
v
(71t) 846-3803
�
All grading of the landscaped areas surrounding the new room
addition are hereby aclmowledged to be in accordance with the City o£
Costa Mesa codes, with a 2� slope away from the addition with all
water runoff going towards the adjacent property lines and the front
of the property facing Fairway Drive.
The plate level is approximately 7-9 inches above all soil areas
on the west side of the building, and the east side is a redwoal deck
8 inches above ground level, and approximately 3 inches below the
£looring level o£ the addition. Rain gutters have been installed in
all areas that would be af£ected by runoff water from the roof and
downspouts were placed in the appropriate places.
I, Ptichael Cavanaugh, as a landscape contractor and owner-builder
assume all f�ther responsibility for this structure.
��fi�����
/-2y'-BS
. ; . • M Cavanaugh, Co. �
2520 FAIRWAY DRIVE, COSTA MESA, CA 92827 -- TEL. (714) 84b-3903 '�
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-
WUNTY OF ORANGE � /
BUILDING DEP'T. , , Permit Na.�
636 No. Broadway � �
SantaAna�casfo�� Application for Building Permit •
Phone: KI2•6211 AND FOR A Plan #3 3
Certificate oF Use and Occupancy
Date.....i�uva�t- ��-t--39§2 --- - --
1. OWNER'S NAME ..............Di!cc- a:..Do1,e�ro*�o-- --- ..... -- --- .._.......
MAILING ADDRESS__.._.�.$th...&..TS99.Y1.8_.S.'�s........
Name
(Archice<t or Engineec)
Address
City
State
Lic. ]
PROPOSED USE :......................
-.. PHONE:..�a3C,t2--.7.��.rj.....
CI TY.. Nsltpnr:t. _Ile2cha...CF1-1.£--'--
Namc ---------D9.ke..L_Cnlegrnve-------..... ...--------
(Convactor)
Address -- -Z$Lh. � ITUi�-St�T. - - ------ ......-
Ctcy --- rSciu�or.t..ae.ac�aT.-C�,1i£---� -- -- .....-- -
State
Lic. No.12`1202_ -- -- - Phone Be8_.���.`�.......- -
,.
JOB LOCATION...._... -- - � 52Q ..... - ITe4 *L.��r...L?r.ive. - - -... - Costa Me3a ....._.. - ---' - - ---- -- .._..
(Hwse No.) (Name of Sueet) (Town or School Diatrict)
�. LEGAL DESCRIPTION: Lot.---------..�5.........------------__....Block ....---...---------..._._----------- Tracc---],2.7.�--------_.._.....__..
(Mctes and Bounds Description—Use reverse side of form) �
4. CORNER LOT ( ) ]NTERIOR LOT ( X) THROUGH LOT ( ) SLOPE OF LOT ( )
i. SIZE OF BLDG.: ...3f�. ;..??........AREA:..._ -9��� -....._SIZE OF LOT:..%O..X.13� ---- .AREA: $2LtiQ- ..................
G. HEIGHT OF BLDG.:-----..._---.1!rL .....................CEILING HEIGHT:...._-R�--_----_........----.NO.'OF STORIES-------�---_.__---.........
7. NO. FAMILIES--_--------------_l.-__-..---_-_Sizc of Smallest Bedroom:--_._zQ--X_lj,---.----_-.--_ Size of Kitchen....],Q--$_j,$_......--__-
S. EXTERIOR WALL CONSTRUCTION:.....Sttacca ........................INTERIOR WALL COVERING___....P].e.nT.�.a.._...__............
(Frame, Stucco, Ete.) (PlasterDrywatl, Ete.)
9. SETBACKS: Front Yard From Center Line'of Street------'...-------- ��.....------------------.._---------'------------------------'------------...--
Nearest Side Yard...._..��............Rear Yard........_..i3Q!.._-.Distancc in Feet Between Bldgs. on Same Lot...........,�)pr� ......................
10. A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STRUCTURES AND USE OF EACH.
11. For
Accessory
Bldgs. and
Similar
Structures:
(a) Footing: Wid[h---------.�/i.°._..--.---.-.---.Depth in Ground---.....�.^.....--'---- Width of Wall`---`q�-'---------..
S �.Ei��--------- CC Matcrial of Floor...........ldOAd.-- ......................
(b) Size of Studs:?_. sc.l,� ............... Pacing....-_.--
(c) Size of Floor Joists:'----.._�--�-&------------------Spacing.--�-------.�.ila........--------------�CC
(d) Size of Rafters: - --..�.. X- h -.......Spacing - � fi° .........- _. -� CC
12. VALUATION OF PIZOPOSED d0�2K: Induding all labor, plumbing, electrital wiring, heating, fire spri�klers, painting and
sewage disposal $---.---_��.q_....�
0
- - ........
13. I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN THIS
APPLICATION IS CORRECT AND THAT THE CONSTRUCTION WORK WILL CONFORM TO ALL LAWS OF
THE COUNTY OF ORANGE AND THE STATE OF CALIFORNIA APPLICABLE THERETO.
Signed:----- ...................---�----------- - ---------------------------------------...---.....
- a w��>
PlansFiled:----.�...�...�.�...�.....---. `� ...................--------
BY`--------`-----------------'--------� - - - ' - - -----------'-----'---------'------...--'-'
(Authorized gent)
FOR DEPARTMENTAL USE ONLY
Bldg. Permit
Plan Check
Total - -
Receipt No.
Paid to •
Date ..---.---.-
5M-B51
FEES:
a�d '
$-- .%. �...�
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