HomeMy WebLinkAbout3020 CLEVELAND AVE - Building Permits�i
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f�W'a4'�h� Applicant to fill in all spaces excepl those within Iteavy Dortle� lines antl sign all approp�iate Oeclantions.
GTY OF COSTA MESA ONSTRUCTION �PERMIT . PER N TRACT NO. LOT NO. UNIT NU. � �
'�roject Address �/�-2/) �/e v e l,a-,�� �J�� ` ' ' _ � � gs/� � - � : � ��
Applicant's Mailing Address ��S 3 �� �/ .d (�-A�t� -
Owner's Name �0��71� S f7J �� Phone ��"��'j�
Address ' �� � �
Arch/Eng. � ' - License No. -
Address ���� �i���
Contractor's Nam r 5 hone �...r.�d,
Address Imailin9l /�-�j � /RlPiO%r/ ` �NAile.��,y�
Ciry�LicenseNa -7 ��� �
UCENSED CONTRACTOR OECLARATION � �
I hereby attirm tha[ I am licensetl untler provisions ot Charte� 9(commencing -
with section ]000) of Division 3 of the Business antl Professions Cotle, antl
my license is in tu}� iorce dntl ettect. ' ; '
'-Licens Clas� `-' ice �e�Ny� �.2��Gr� �
� — ��<�J
Date � � 7 5'g t �. //
WORKERS' COMPENSATION DECLARATION �
' hereby affirm that I have a certificate ot mnsent to self-insu�e o� a certiticate
WorkerY Compensation Inmrance, or'a. certif' tl copy Ihereof.(Section
00, Lab. C.) •
Po1icY No. � ��a ComPanY, . �
n'�y �,, �crfifietl copy is hereby tumishetl.
CJ Certifietl cop is tiletl with the tity/B�iltling D isi h�/ ,
Date ��g ��� APplican��
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Thissection neetl not be completetl if the permit is tor one huntlretl ($300) o�
less). � . - :
I certify that in the performance ot the work (or which this pe�mi{ is issuetl, I
shall not employ any person in any manner so as to become subject to the
Workers' Compensation Laws of �California. �
Da[e Si9nature -
NOTICE: Ii, after making this tleclaration, you snoultl become subject to the
Wo�ken' �Compensation p�ovisions of the Labo� Cotle, you mus[ torthwith
comply with 5uU provizions or this permit Shall be tleemed'�evoketl.�
CONSTRUCTION LENDING AGENCV ' ' � ` '
I hereby afiirm that there is a construction lentling agency for the pertormance
of the. work for which this permit is issuetl (Section 309� Civ. C.)
Lentler's Name �
Lentle�'s Atltlress - ,
OWNER BUILDER DECIARATION� � � �
I hereby,affirm that I�am exempC'from [he Cont�acto�'s License Law.for Ihe,
following ieason (Section 7o3L5 Buslness antl Protessional Cotle: Any city or
countv which requires a'permit to'construct, aiter, improve, tlemolish or repair
any structure, pnor to ¢s issuance, aiso'reqwres me appncant ror surn permrt
-� to �iie a signetl statement tM1at ne/she is licensetl pursuant to the provisions of
'[he Con[ractor's License Law (Chapter 9(mmmencinq with Section 7000) of :
7ivision 3 ot tM1e Business antl Proiessiorls �Cotle) Or thdt he/she is exempl
erefrom antl the basis (oi Ihe allegetl exemption. Any violation of Section
-31.5. by any applicant for d permit subjects [he�applicant to a civil
�nalty, ohnBt more than five huntlretl tlollars (5500). .
❑ I, as owner o( ihe property or my employees with�wa9es as their sole�
compensation, will tlo [he wo�k, antl the Struciu�e is not'intentletl o� ofteretl
for sale (Section 7044, Business antl Professional �Cotle: The Contractor's
License Law tloes not apply to an owner oi a,property wno builtls or improves
�hereon, antl who tlo¢5 SucM1 work_himsel//herselfb� through his or her own'
em0loyee5, provitletl ihat such improvements ate not intentletl or offered for
sale. If, however„the builtling or improvement is sold within one year of com-
pletiom, thepwner will have the bu�tlen of proving he/She'tlitl not builtl or im-'
prove fo� tbe Ourpose of sale). , � i . •
❑ I, as owne� of the property, am excWSively mnt�acting wi[n IicenSetl con-
tractor5to construct the project (Section ]044, Business antl Professions Cotle:
The Contractor's License Law does not apply,to an owne� of Drope�ty who
builtls or improves thereon, antl who contracts for such project5 with a con-�
Vactor(s) iicense punuant io the Contractor's License Law). Pam aware that
proof of thei� Worker's Compensa[ion insurance shoultl� be provitletl to me.
❑ I am exempt untler Section , B. & P. C. for this reason �
Date Owner ' '
I hereby certify'that I have'reatl this application and state thaYthe above
,niormation is correct: I agree to comply with al1 city antl county ortlinances
gntl state laws relating to bviltlin9 construction, antl hereby authorize repre-
:entatives of ,�hi5 city to enter upon the above-mentionetl properTy for
nspectian [� oses. A g, _�
Signature/���i/SA ,(„/ / Date
TVPE OFCONSTRUCTION '� LJ NEW LJ ADD LJ_ALTERATION LJ REPAIR
❑ CONVERSION ❑.DEMOLISH- ❑ OTHER � � _
' DESCRIPTION OF WORK/USE OF BLDG.
TYPEOFPERMIT. ��, ' GRA�ING FOVNDATION STRUGTURAL .
❑ TENANT O ELECTRICAL. PWMBING ❑ MECHANICAL .
❑ OTHER � � � _ �
PROJECT,DESCRIPTION S4. FT. ocCUPANCv
� �CONSTRUCTIONTVPE VALUATION.$
ZONE ' GRADINGCU.VDS. ACRES'
Remarkr. � ' � �
Sink
cflow Preventer'
<flow Irrigation
Dishwasher
Drinking Fountains
Floor Droins
Ploor Sinks � �
Gas Seivice �
Interceptor5
Kitchen Sink
Lavamries '
P-Trap
Roof Drains •� -
Reinspection Fee
Under Ground
Structural
Showers
. Service Sink � "'-
' Sewer Cap ' , �
Sewer Connection
$013f COII¢CtOfS
Solar Piping
Solar Tank •
Swimming Pool w/Spa
Urinal -
�ts Water Closet :
Water Heater
. w�re, ce.,,�..e . '
' LaundryTrays'
� $15 - � Issue Fee .
, MFf.HANIf.CL �
- ��.��... ��y . _. .
Exhaust System ❑ Multiple ❑
Firepl/Fact. elc ICBO #
Heating System & Ducting �
' � ❑0-100;OOO�BTU'�100;000BT
LDrivers' License or Sc z ������— ' I �I Rainspection Fae ' I., $15
CMF 0865-46, rev. 10/84 White - Builtling; Canary - Applicant; Pink - Accounting; Goltlen�otl - Assessor
Hood or Typel ❑ '
Canopy" Type I I ❑
�..
❑0-100,OOOBTU ❑700,OOOBTU
System Repair/Alteration f �
FireDampers �
Registers . � , �
laue Fee
•$ 3
FEES
a
$ 3
A.P. # •
S Main Buildin9:
E
T Front
A Rear
C Right -
K Left '
$
Ping. Ref. # '
Planning Notes:
Automatic Washec - '
ConsVuction Pole.Sub. �
Cooking Unit , -
8134 5/19/E7
. ' _.
- Zone
Accessory Building: -
_ ' ,
Parking Req./Provided
ELECTRICAL
Dryers LJGas •IJElectric
Fan �i: �
F.A.U.
Fixtures - - � . ' `
Device Boxes '
Outtets . �. . '
Garbage Disposal
Generamr �0-5 KW �5-15
. Z
� O
N
I;
N
G
R
` E
. Q
- M
•. T
s
Transformer ❑ 15-50 KW
' ❑ SO+KW
�
Meter ❑up to 100 amps '
Merer pover 100 amps
Sub Panel
Motors �0-1 HP O1 %= 8
Inc: Solar �9-15 HP ��16-15+
Microw`ave � � " " � - " '-
Pole Light �
Range � � � . '
Si9n '
. Standing Sections'
Trash Compactor i
,I Reinspection Fee ' � I $15 I I Issue Fee
DEVELOPMENT'SERVICESREQUIREMENTS:
Zoning Approved By '
Building Approved By
$ 3
' • i SUMMARV OF FEES � • � � �
BUILDINGPERMIT $ 'SMIP. ` , $
PLAN CHECK $ PERMIT�
PLUMBING , $ �•C-� �SSUANCE �. $
PLAN CHECK 25% $' ENERGV P.C. $� ;
ELECTRICAL , $ GRADING $
PLAN CHECK � 50% $ � MICROFILM $
MECHANICAL. �$� TOTAL FEE i$ S�
PLAN CHECK 25% $ ; •
CONSTRUCTION AND PLANNING POOI PA
APPROVALS Permit # Date Inspector qppROVALS � Permit # Date Inspector
= 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
� 2. Soil Pipe-Undrgrnd. � . � ' 53. Steel Reinforcement � �
3. Electrical Conduit Utility-Undrgmd.� • 54. Forms �
4. Electrical Conduit-Undrgrnd. � 55. Electrical Bonding -- � �
5. Steel Reinforcement ' � 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. • • . 57. APPROVAL�TO COVER-GUNITE
7. Footings � � � 58. Electrical Conduit-Undrgrnd. '
8. Foundation � 59. 'Gas Pipe. O Undrgrnd., Test � -
9. Water Pipe-Undrgmd. � � 60. Backwash Lines, P-Trap, O Undrgrnd. �
10. Structural Floor System ' 61. APPROVAL TO DECK � '
11. Property Sewer Line & House 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 _ 66. Solar System-Final - . .
. 16. Rough Electric Wiring ' . . 67.� Fencing & Access Approval . � ,
t, 17. Rough Wiring Sign� " � 68. APPROVED FOR PLASTERING '
]8.. Rough Electrical-T Ba�r Ceiling � 69. POOUSPA SYSTEMS FINAL �
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT ' � �
20�.� Rough Factory Fireplace ' , APPROVALS Permiti# _
21.� Ducts, in Structure ` � 70. Underground Hydro' � .
22. Ducts, Ventilating 71. Product Piping OGas ❑Oil '
23. Gas Pipe-Rough & Test 72�. Underground Flush -
24. Roof Framing . . � � 73. Undergrnd. Storage Tank O Gas ❑ Oil �
25. Roof Sheathing " ' , " 74. Overhead Hydro '
26. T-Bar Ceiling (Structural) & Monocoat ' � 75. Dry Chemical .
27. Frame and Flashing � 76. Dry Standpipe , � .
28. Lathing & Siding � ' 77. FIXED SYSTEM FINAL
29. Insulation � � . 78. FIRE PREV. FINAL � �
30. Drywall Nailing � � -' � HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat � �� 79. FINAL INSPECTION . -'
32. Electrical Power Meter-Final � 80. FOOD CERTIFICATE ISSUED
33. Final Electric ' � ' Notes: - - - �' �
34. Final Heating & Air Conditioning � � � �
35. Final Gas Pipe-Test � � ' � .
36. Hood or Canopy � ' - - ' " � ' - �
37. Final Factory Fireplace , � . - � .
38. Final Plumbing � � (,� ' .
39. Water Service-Final . .
40. Gas Service-Final . � - � ' � '
41. Solar pomesticFinal � � , � '
42. Backflow Preventer ���~� - � �
t�
43. Backflow Irrigation . ' � � . � - � �
44. Landscape Irrigation System ;' ; , ' � , � >
45. Sound Attenuation � � � � • • �
46. Handicap Regulations =` � � ' � � � ' �
�
47. FINALSTRUCTURE&BUILDING � . ' . .
48. Special Requirements Completed � ' � � �
49. Electric Release to Edlson � =� . � _ . _ �
50. Gas Release to Southem Califomia Gas Co , ' � . ' '
51. CERTIFICATE OF OCCUPANCY ! '
No. Date . . .- � - - r ' � � . ,
.� -�. � u�i u 1 �/' �
� aoa ann�ss 3020 Cleveland Avenue auii.vixc r�iT No. 27233
�y GENERAL CONTRACTOR OP1neT�-B1dY�. DESC$IPTION OF WORK Add plaYrm•t0 res.
� AP No, l�F1-141-40 LOT TRACT FIAE ZONE Vni.UE $ 2, 97�.00
�INSPECTIONS Signature Date GROUP I TYPE V ZONE R-1 _
SoIl I PERMITS ISSUED
�,,,, SUBCONTRACTOR ,,.,.,, i Ti.�...Fnn I �;.,.,.
or
, • �': :�33
� .COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 - COSTA MESA, CALIFORNIA 936R6
For Appllcanf fo Fill In Complefely
TYPE OR PRINT
BUILDINO � '�Al C.t�VrrV{lYD TV�
ADDRE58 Gp,/
COSTA ME3A. CALIFORNIA
Ill�? Ll
A STAT6 n C/ Ln T6L.
eo: o� ��oo�. �
� YCfsACK
DESCRIPTION OF WORK
T.
0 UII6
1 HGRC9Y ACKlIOWldD06 TIIAT 1 XAV[ RBAD TM�B APPLIWTION
AND eT�TB TNAT TX6 AGOV6 It CORR6cT�ANO �ORBe M cOM•
PLY WITH ALL CITY OnRpDyI�IUNCp AND iATi WD R[OYLI1i1flY
BUILDINO CONeTRU^�'Y _•' / -
816NATUREOP � j,R��
PERMITTHB-
AUTXORIZiD AGQNT
JUPI30-67crisr.003047':; �`�; ,:�:1L.QD
APPLICATION POR PERMR
BUILDING
for Office Use Only
- R[C[II! NO. PI
=�
� n a ccrv: a
� O-�
� � P C P ✓P_
ZONING
MO.O� YitO►N�W
�uw 'Z lUILDINO
L[OAL
YAROE MPROV H
MAIN BUILDINO
RGR 4
DIYTANCI
MAIN BLC
VM. �G
r7 -I-r,��-� Na �4�39
- 141- 4U
�,NANO BHALL G6 LE88 THAN
�. L
fU.�B.C.RlQUIXHMENT:
D YARDSAPPROV6O
ACCED80RY BUILDIN6
�� ACCE
DATH
DAT! - 7 V ' l9
a
07
. �
80. Ff. �
0
ill[ AMOUHf BHOWN UNDBR VALUATION I8 FOR TX6 j
■URPOB� OP �BTApLI8HIN0 A PlRNIT F88 ONLY. ZS
_UATIOIi /� '�
� N
PERMIT FHE E
��� /1 e� ..�.-.,vrv a !D � k.
ER MOON� Thomas B.
� JOB ADDRESS
�� GENERAL CON
�AP No�-l�t
INSPECTIONS
SOIL
� GAS
WATER
- ROUGH PLUMBING
PROP. SWR. LINE
HOUSE CON.
MISCELLANEOUS
ROUGH HEATING AN� AIR CON
TEMPORARY SEftVICE OR POL
❑N�ERGROUND � POWER
ROUGH WIRING
TRENCHES U FORMS U STEEI REINF.
FLOOR SYSTEM
BONO BEAM � STEEL REINFORCE �
SHEATNING
FRAME AND FLASHING
LATHING - IN n OUT n
PLASTEft,BROWN COAT
STRUCTURAL, FINAL
HEATING, VENT., REFRIG. AND
PIUMBING, FINAL ANO GAS TE
DATE lp_2i
BUILDING PE
RIPTION of WORK Encl�
ZONE VALUE $ 251
)UP I TYPE V
SUBCONTRACTOR
' 33749
. ' ' COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely
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�1�T7_0-�?c�is�Qf1Q_A a:�
APPLICATION FOR BUILDING PERMIT ,
OWNER ' A.P. NO. � —
BUIIDING //
�'41L ADDRESS '3Q /5
Z ADORE55 O V � 2L
d U CITV eAS�. � NOL�4-Ip•7� TRACT J
Z
Z Q CONSTRUCTION W A D
O N LENDER
am
J � BRANCH
J N OWNE
mJ ADDRESS
J m ARCHITE TE _
a EER
WU Q � FIRE �
Q ADORES Ci5 ZONE
aw
APPROVED
W Z CONTflACTOR BY
J �.
mZ
J p� ADDRESS
W W TEL. ZO NO.OF
Z.� � CITV NO. P��
w� STATE ' . CITV ' . �'ARDSAPPROVE
y� IIC. NO. �UC. NO. MAIN BU�LDING
� � SIZE ' NO.OF BLIX'.S. � ' ��
OF LOT NOW ON LOT M
VSE OF
EXISTING BLDG. I(,� p
H SIZE OF / � NO. OF
Z NEWBLDG. ROOMS STORIES L.SID
U �EXTERIOFiWA ROOF - i "
COVERING COVERING -REAR FT.
J. USE F BUILDI G AND ORK TO BE P RFO MED DISTANCE BET.
a "V L � L ' ' ti1A1N BLDGS.
a
Q. VAR. #
O . ' C.U.P.� '
� �• APPROVE
N
Z .
0
UI hereby acknowled8e that I have reatl this epplication antl stare ,
� ihat the above intormation is correct and agree to comply with ,
� all laws reguletinp builtl��g construction, entl 1 shall not employ .
F, any parsan in violation of tha workman's compensetion laws-of '
y tha State of Califomia..
? I hareby certify that 1 em properly licansetl as a contractor untler SQ. FT.
tha State of Calilornie Qusinass and Protessions CoCe, Division 3, THE AMOUNT SH
Chapter 9, and Mat such licensas are in full forca antl affect, or I TNE PURPO6E OF E
em enampt fram Me prOvisions of the Statt of Californfa Business VALUATION
entl Protessions Code, Di�ision 3, Chapter 9. '
' Sipneiure � rn ` / � /r�� _—�'
Pe�mit 0�..�— L 1 I �+-� �%T�/ $ �
�� J
Aut�orizetl ABent �
VALUE
$
—�/
/.L GROUP �
OATE /O�L�
USE OF NEW��GE
BUILDING ��
� YARDSAPPROVEO
BET. MAIN &
ACCESS. BLD
DATE
m
m
0
VALUATION IS FOR �
A PEHMIT FEE ONLV: m
S
�— N
E $ �
m
K$ E
0
� _ LL
$
OWNER MOON, THOMAS DATE 4-27-70
JOB ADDRESS 3020 Cleveland Avenue BUILDING PERMIT N0. 31763
GENERAL CONTRACTOR F. Palmer DESCRIPTION of WORK Communi t�. xlock wat t
AP No. 14 -14 -4 LOT TRACT FIRE ZONE VALUE $
INSPECTIONS Sianature Date GROUP .T TYPE III ZONE R-1
�qs SUBCONTRACTOR
WATER Plumbin
ROUGM PLUMBING
PROP. SWR. LINE n HOUSE CON. I—I
H
UNDERGROUN� U POWER U
ROUGH W10.1NG
TRENCHES �1 FORMS � STEEL REINF.
��t i
FLOOR SVSTEM
BONO BEAM � STEEL REINFORCE �
SHEATHING
FRAME AND FLASHING
i i
PLASTER,BROWN COAT
HEATING. VENT., REFRIG. ANO A.C., FINAL
ELECTRIC, FINAL
BUILOING, FINAL
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.eOX1200 COSTAMESA.CALIFORNIA92626
AP327'70cnsnOO1582 o,t****5.��
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely . REceiv o ev DATE RECEIVED DATE ISSUED
BUILDING � �/�a ` O
ADDRESS O U L J N
. A.P. NO. � � � PERMSI� NQ,e��
OWNER U 6U� rr�
MAIL i ``\ '� BVILDING �O
ADDRESS 301 LE � "��V—� /aDDRESS
TEL. TRACT ,'� LOT BLOCK
cirv �.-\ . No.sK - 85
CONSTFUCTION ,,1 ' NEW ADD A P
LENDEfl - 'VOA�E.�
BRANCH
OWNER
ADDRESS ALUE �
AflCHITECT p TEI.. S � '� $
OR ENGINEEF NO. i
FIRE
ADORESS ZONE TVPE OUP
� APPROVED �L�
CONTRACTOR' �(.�Q �� BV �� DATE
ADDRESS (�%OPC.R ,ZON NO.OF USEOFNEW
TEL. p�q�.�,5 � gUILDING
CITV NO.�(LS_ � �
STATE CITV �ARDSAPPROVED VARDSAPPflOVED
LIC. NO. LIC. NO. MAIN BVI��ING ACCESSORV BUILDING
SIZE NO.OP BLDGS. , -(FROM C/L STREET)
..��
OF LOT NOW ON LOT ' FRONT FT. FT.
VSE OF C //�/ n �
EXISTING BLDG. LS. �1 ( E SI E� F, `—'"FT�'
SIZE OF NO.OF
NEWBLDG. ROOMS STORIES L.SID FT. —FT'
EXTEFIOR WALL ROOF . �/
COVERING COVERING REAF FT. FT.
USE OF eUILDING AND WOPK TO BE PERFORMED , DISTANCE BET. BET. MAIN &
MAIN BLDGS. ACCESS. BLDGS.
�/�/ VAR. # DATE
L iJ� /- ^NC ��/`. C.U.P.# APPROVED
C(�/S�L� E� SYLI'`• / I � APPFOVED �1 D
I hereby acknowiedge that I have read ffiis application and state
that ffie above information is correct antl agree to camply with
all laws regulating builtling construction, and I shall not employ
any pe�son in violation of the workman'S compensatiOn laws ot
the State ot Califomia.
I hereby certify ffiat I am properly licensetl as a conttactor untler SQ. FT.
the State of California Business and Protessions Cotle, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, antl ihat such licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV:
am exempt trom e provisions of Me State of California Business ' VALUATION
and Professions o� �C pte i� !���
PERMIT FEE $
Signat
Permittee $ PLAN CHECK S
Authorizetl Agent Q ` � �i �� �)
3 U�J TOTAL FEE $ p[ /J'y
E
`o��
LL
Lor 7• rRncr 4395
�- , � � o szso
�. �
• COSTA MESA BUILDING-SAFETY DEPARTMENT
r P..O. BOX 917 C08TA MEBA, CALIPORNIA
Fo� Applieanf fo Fill In Complefely
- g� TYPE OR PRINT �
BUILDING l.�izo � ! i. ... / . /) . _
COSTA MESA. CALIFORNIA
■ MAIL
NONE
■ STATE
TEL.
F�EE RECEIVED
, � / JAN 3 11962
�N FINANCE DEPT.
CITY OF COS7A MESA
APPLICATION FOR PERMIT
BUILDING '
For O#ice Use Only
� RECE�YEO BY I DATLe�
� 6 z2 BUILDING '
ADDRESS
-----_ COSTA MESA,
FIRE
ZONE TYPE
APPROVED
1 . N � lLL �
NO. oP. BId08. O
NOW ON L�T
68Tp6GK LINQ PRON //
�NTeH OP BTReeT REAR VARD G
/ /
SIDE YMO LEFT RIGHT
DESCRIPTION OF WORK
EXTBRIOR WALL � ROOF QOM�p
COVHRINfa STUCCO COVERING SI
USE OP BUILDING AND WORK TO BE PERFORMED
ZONING
ZONH � NO.OP U6E OP NEW $/�/
�� I I FUNB � BUILDINO y�I�'
LEOAL / y- �'] 7-R y 3 9�
DHBCHIPTION L-4% /
A. P. NO.
YARDS� EVES
APPROVED ALLOWED
(C6NT¢R LIN6 9TJ y�/ /y� /
FRf1NT / / FT H
APPROVED
� FT.
`S FL .�_
z� ��
d�
u'
i H6RElY AGNNO�GLCDG! TXAT 1 HAVE RlAD THIB MPLIWTION THE AMOUNT BMOWN IINOER VALUATION IB POR TH6
AND 9TATfi TXAT TX8 AlOVE IB CORAEGT AND A6PE8 TO COM- pU1iP082 OF EeTABLI8HIN6 ♦ PERMIT FEE ONI.Y.
PLY WITN ALL CITY ORDINANCEB AND BTATE L�WB RE3Ul.�TINO
Bu1LDiNG CONBTRUCTION. VALUATION
SIGNANRE OF . �� ��L /��- � � PERMIT FEE S ���
PERMITfE $ �,I,�O��
/ P�AN CHECK $ � �i��
AUTHORIZED AGEN7 y— 7 _.G-
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