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HomeMy WebLinkAbout182 COSTA MESA ST - Building Permits • 4`00144- CITY OF COSTA MESA • BUILDING DIVISION `-, , DEVELOPMENT SERVICES DEPARTMENT ERMIT NUMBER 11711 ITV o PERMIT y�ro�4*, • B02-01732 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.BUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 182 COSTA MESA ST Status: ISSUED Suite: Applied: 10/22/2002 Vicinity: BACK OF PROPERTY Issued: 10/22/2002 Parcel Number: 42603208 Zoning: Applicant: CRANK, JIM ISSUED BY: Address: 126 COMMERCIAL WAY Phone: (949)548-5569 COSTA MESA,CA Zip: 92627 Owner: BEE, PAULA ANN Address 182 COSTA MESA ST Phone: COSTA MESA,CA Zip: 92627 Contractor CRANK BROS ROOFING CO INC Address: 126 COMMERCIAL WAY Phone: (949)548-5569 COSTA MESA,CA Zip: 92627 License: 794724 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF EXISTING, INSTALL FELT AND APPLY 30 YEAR COMP SHINGLES.APPROX 900 SQ. FT. DWELLING IN REAR OF PROPERTY. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $2,143.00 Permit: $83.25 Claim Valuation: $2,143.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $83.75 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 • ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work Is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) • A WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the • work for which this permit Is issued. I e and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. y workers'compensation Insurance carrier and policy number air- Carrier: Carrier: Policy Number: (This section need is completed it the permit is valued of one hundred dollars($100)or less.) ❑ I certify that n the erformance 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' compensati la of California,and agr=- .•i.. if I sho • •,t•-• e subject to the workers'compensation provisions of Scroll 3700 of t e Labor Code,I shall forthwith comply with t ovisions. , Applicant Slgn�etVre. / Date: ° WARNING.:FA1LLlRE 0 SECURE WOR COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES D CIVIL FINES UP TO ONE HUNDRED THOtJSII E($1CO3(00).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTO 0•CLARATION: I hereby affirm that I am lie•nse•under provisions>o�co r::cing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# �— Class p Contractors Signature: — / trall•Ma•-- Date: CONSTRUC ON L - •ING AGENCY: ❑ I hereb that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any 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).): ❑ 1,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an Owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has al any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire epartment of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermlt for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes j�No (Section 65850.2 Of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Colic Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have ell of the disclosures prescnbed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No —(If _._ ro_._. at 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and dty ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that t have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described pr for inspection purposes.I ea occupy or allow occupancy of any building authorized by this permit until final inspection. Signatue Le rsG ) W/( Dal e '•"7Cn uthorized Applicant `-J Datee ;ODE INSPECTIONTYPE PATE MOM ;OGEE INSPECTIONTYPE PATE It4TIBLS 1618 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final � 208 Final Plumbing 200 Final Re-Root / 210 Final Electrical 201 Final BIocWRetaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign _ 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 1111 zoT _ --- axy -- — 1 R X 20 � -' -e '1.2 e 16 . 1 ! ' 031r1 \ol)� a�. � � lac 1.4 $1 r cA. • LC I ,ia // , • • I . • 1 ' U APPROVAL OF THESE • • APPROVED STRUCTURAL PLANS DOES NOT CONSTITUTE APPROVAL City of Costa Mesa Building Dept. OF PLUMB N�, ELECTRICAL OR A��— .. i ..DATE CONTINGENT INSTALLATIONS. .... 18..._I THESE PLANS MUST BE ON JOB AT ALL TIMES MAKE NO CHANGES WITHOUT PRIOR APPROVAL Peii�mt- yLS7D/D OF DEPT, f l -1f^ (J THE ISSUANCE OR GRANTING OF A PERMIT OR APPROVAL THIS NUMBER MUST ACCOMPANY OF PIAS AND SPECIFICATIONS SHALL NOT, BE CONSTRUED ALL INSPECTION i0N REQUESTS TO BE A PERMIT FOR. OR AN APPROVAL OF, ANY VIOLATION •OF ANY OF THE PROVISIONS OF THIS CODE. NO PERMIT PRE, SUMING TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF THIS CODE SHALL BE VALID, EXCEPT IN SO FOR BUILD:N:S WHERE PERSONS ARE TO FAR AS THE WORK OR USE WHICH IT AUTHORIZES IS LAWFUL. BE EMPLOYED, WE SU,GEST THAT THE • SLATE O,' CALIFORNIA DIVISION OF THEISSUANCE DFA PERMIT BASED UPON PIANS AND INDUSTRIAL SAFETY BE CONSULTED FOR SPECIFICATIONS SHALL NOT PREVENT THE BUILDING MOW. FROM THEREAFTER REQUIRING THE CORRECTION OF ERRORS ADDITIONAL REQUIREMENTS. IN SAID PLANS AND SPECIFICATIONS OR FROM PREVENT1NQ BUILDING OPERATIONS BEING CARRIED ON THEREUNDER WHEN IN VIOLATION OF THIS CODE OR OF ANY OTHER EIRDLNANCE • OF THE CITY. COUNTY OF ORANGE A-- itt BUILDING DEPT. - Permit No —3 -- y' 1 636 No. Broadway Santa Ana,California Application for Building Permit Phone:KI 2-6211 AND FOR A Certificate of Use .and Occupancy -c - Date 3 — 1 0 — s-/ 1. OWNER'S NAME p/.!3.,62:e. !ot.1 • �r A 'ig PHON.EE- • MAILING ADDRESS.._-./... �/ c - - --- f---c T CITY 41 -e/ ci?'t-(24-4-0 Name.. .. l d.- , t a. Namein--e.-174a4a ��//���///''"' -(- rchitect or Engineer) (Contractor) Address _. Address • City City State State Lic. No._ Phone Lic. No Phone PROPOSED USE- -lr_�Pj1-f l`P.F P?-Q- 1 114. . �[ 2. JOB LOC - ATION----I- 4 (-sYV c ' /12/2 , -ssei /e4°w ., 2n2/. (House No.) (Name of Street) (Town or School District)� ��� 3. LEGAL DESCRIPTION: Lot / P a Block Tract / /f/`PP-1 -���Y (Metes and Bounds Description—Use reverse side of form) 4. CORNER LOT ( ) INTERIOR LOT ( y)' THROUGH LOT ( ) SLOPE OF LOT ( ) I. SIZE OF BLDG - g ei X...,z�.AREA• 4fWQ SIZE OF LOT- 'C-/2 / C-6 AREA- —7 S (.p G. HEIGHT OF BLDG.:_./ ea, I CEILING HEIGHT- e NO. OF STORIES 7. NO. FAMILIES -- Size of Smallest Bedroom- Size of Kitchen ---- 8. EXTERIOR WALL CONSTRUU!ION- 7 _.-tiAT INTERIOR WALL COVERING (Frame, Stucco, Etc.) (Plaster-Drywall(Etc.) 9. SETBACKS: Front Yard From Center Line of Street j D,L, .7-3- 6 11.4. I k ` ise4u ` ) 1' © r r i Nearest Side Yard � Rear Yard...s3 Distance in Feet Between Bldgs. on Same Lot L/ 10. A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STRUCTURES AND USE OF EACH. // // 11. For (a) Footing: Width /L/ Depth in Ground / "7 Width of Wall 1 Accessory / �� Bldgs. and (b) Size of Studs SCX `� Spacing � "CC Material of Floor ���✓C^--^ 4 Similar Structures: (c) Size of Floor Joists- Spacing _ "CC ' (d) Size of Rafters- X • Z Spacing (- "CC • \ 12. VALUATION O$---4-W72-- F PROPOSED WORK: Including all labor, plumbing, electrical wiring, heating, fire sprinklers, painting and , sewage disposal � v —c 0 // 13. I HEREBY CERTIFY THAT TO THE BESTAOF 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 CAEIFFOORNIA APPLICABLE THERETO. / , `f) Signed• /id i `; "'� - � (Owner) Plans Filed• J t -i .-e l/ By- (Authorized b� ��a t (Authorized Agent) 0 FOR DEPARTMENTAL USE ONLY FEES: L/ CHECKING BY Bldg Permit GROUP APPLICATION HEALTH Plan Check $ TYPE = % FIRE Total • - • $ /)/ ZONING DIST. / PLANS AND MARSHAL Receipt No. - .-..-.6, 9 1 s-. MAP / SPEC'S STATE Paid to - - OAP 'Pt-.• SHEET NO CORRECTIONS ENGINEERk.% Date 1' /Lr—S`/ VERIFIED CAL PE C. WSUfi \J `l C. UJ. D �! IID , COIaNSV. J O.D•n�r•- fPJ`;, TOR ' _.,-s- DATE ✓ - 1 % \M-2.51 E f4,J. ./ 1 , • Y ,, .FES AND BOUNDS DESCRIPT._.4: -5-1-ei ,/. 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Permit No. _5 gg. 7 9-42. 636 No. Broadway Application for Building Permii— Santa Ana, California Phone: KI 2-6211 AND FOR A '3; 7 4 7---- Certificate of Use and Occupancy Date / r- _s-/ I. OWNER'S NAME Xit--.6.-1--e ' oia•-€.--, PHONE:.4er,..6r1" i MAILING ADDRESS._/ tr P- ea.... - c7pg....... _eel._ CITY alit-- ‘7,•2^e-a_, Name Name (Architect or Engineer) (Contractor) Address Address City City State State Lic. No. Phone Lic. No. Phone PROPOSED USE: .6:202-4re A VC- tete-aft Lir- •.• 2. JOB LOCATION( / g- 2............- ) e":;.%C--- APACk- efre1/4S) (House No.) ( ame of Street) rr... (Town or School District) 3. LEGAL DESCRIPTION: Lot .5.-Blee-.e.e.. (Metes and Bounds Description—Use re-serse side of form) 4. CORNER LOT ( ) INTERIOR LOT ( '-1 THROUGH LOT ( ) SLOPE OF LOT e ( ) / 5. SIZE OF BLDG./47.X €P 43 AREA- -.2"c"_a___ SIZE OF LOT• -5-6 X. AREA 1 t . , ' _...,":„. , 6. HEIGHT OF BLDG.: CEILING HEIGHT: 7 20' NO. OF STORIES / ' 7. NO. FAMILIES Size of Smallest Bedroom: Size of Kitchen: 8. EXTERIOR WALL CONSTRUCTION:eren INTERIOR WALL COVERING (Frame, Stucco, Etc.) . (Plaster-Drywall, Etc.) .0' 9. SETBACKS: Front Yard from Center Line of Street %tli 4 Nearest Side Side Yard •S 1 Rear Yard Distance in Feet Between Bldgs. on Same iede4 0 ' raeli:L _ 10. A COMPLETE PLOT PLAN IS REQUIR SHOWING ALL STRUCTURES AND ,Ise:242 SE OF 11. For (a) Footing: Width 1/61 ifiel-Deh in Ground Width of Wall Accessory Bldgs. and (b) Size of Studs: Spacing "CC Material of Floor Similar Structures: (c) Size of Floor Joists: Spacin "CC (d) Size of Rafters: 4:g "CC 12. VALUATION OF PROPOSED WORK: Including all labor, plumbing, electrical wiring, heating, fire sprinklers, paint- ing and sewage disposal $ An.. , a-0 13. I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGEAND 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:....... (Owner) Plans Filed• . C..; By• • ::-- (Authorized Agent) C-. FOR DEPARTMENTAL USE ONLY . Nr FEES: 'C./ CHECKING BY .....".., Bldg. Permit - $ A CV GROUP . .„...e.7 .. .- APPLICATIO dem HEALTH Plan Check - $ t...576,1 TYPE .... '' IRE ---:. ZONING_SS- ......._.., Total - - - $____.-...;- //..../..-kai DIST. MARSHAL -: Receipt No. - - ....___ ...• la-.-- .b. MAP dt PLANS AND SPEC'S STATE Paid to - - fer.dir- SHEET NO ..,,c — CORRECTIONS ENGINEER Date 41 VERIFIED CAL . Ch PERMI SUED BY: .„ . DATE 1007 g eare A/ .., .., . - . . • 2 5M-7-50 , hs.4•110 or- METES AND BOUNDS DESCRIPTI.,.4: 10 21,0 31,0 4,0 51,0 610 0 o • tel • 0 In 0 • 0 N. o _ C 0 rn 14 OWNER NOSKER, FRANK DATE 1-11-by .JOB ADDRESS 182 Costa Mesa Street BUILDING PERMIT N0. 20�_ GENERAL CONTRACTOR Owner-Builder DESCRIPTION of WORK Tnstat7 Sliding Glass Doo. 'v A' '1. J18-054-57 LOT 82 TRACTNyt,HgtsFIRE ZONE VALUE $ ?00.00 � It`. :CTIONS Signature Date GROUP I TYPE V ZONE 11-2 SOIL SUBCONTRACTOR PERMITS ISSUED GAS Date III Number I Signature ,.., WATER PImbi ROUGH PLUMBING ��� i_ or dl)� 'W, •re if", /,- j( PROP. SWR. LINE❑ HOUSE CON. ❑ I SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND 9 POWER 9 ,. ROUGH WIRING Heating and Vent. TRENCHES 9 FORMS 9 STEEL REINF. 9 FLOOR SYSTEM BOND BEAM n STEEL REINFORCE 9 SHEATHING cc FRAME AND FLASHING y{ !ll�. /--/4-63 LATHING — IN 9 OUT n PLASTER, BROWN COAT ' S" TURAL, FINAL .�s�/[//�y��',t{. E > trjc /�/ �{ HL. AG, VENT., REFRIG. AND A.C., FINAL 44-' � V' V .O �� 1-3-of ddDJ , . PLUMBING, FINAL AND GAS- ri—/5"-bie 744 ELECTRIC, FINAL BUILDING, FINAL /-1.84-6� 280 I 0 JAR 11-6600 386 d*****3.00 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92620 • For Applicant to Fill In Completely • APPLICATION FOR PERMIT TYPE OR PRINT BUILDING Bu1LDINo /✓n c // For Office Use Only ADDRESS /P 2 - ` 0µ IS, Me S�-5 }9{q1 y'T.1 ry�g7 IP RECEIPT NO. 2V V11 �,/ COSTA MESA. CALIFORNIA /' R[C�[I�p y, DATE RECEIVED DATE DATE ISSUED Q. OWNER f"✓A of it jVO S�kw " �.IL.[v 1-1/-(C/0 / "i/-b0 MAIL L! BUILDING /&� �� .,{.- _�f{. ADDRESS (.�' 2- -Co S.A 4 st - ADDRESS] _([(,J JIZ� n/J / TEL•�/ 6r.. ZONEFIRE�t..) -E F. GROUP CITYIfiO S.YZ A/ic S/^— NO.FIYL HITECr TQL APPROVED / _T BY ,eDATE7/--. _ NGINEQR NO. �__ ZONING 5,�4QI ADDRESS IONS q NO.OF USEOr NEW �'1JJ �. s/ R -L l PLANS O I BUILDING —Q_A '- '-� CONTRACTOR v LEGAL ADDRESS 17 DECRImON J(1 t e? y./174-, CITY A.P.NO. / I - h c -1-/- / NOTE: NO SAVE OVERHANG SHALL BE LESS THAN STATE i TEL SO'TO SIDE B REAR P.L LIC.NO. NO. EAVES SIZE I NO.OF SLIM'. ALLOWED AU.B.C.REQUIREMENT/ OF LOT NOW ON LOT YARDS APPROVED YARDS APPROVED USE OFLI'. l n MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. 7 (PROM C/L STREET/ SETBACK LINE FROM / FRONT FT. FT. CENTER OF STREET REAR YARD SIDE YARD LEFT I RIGHT R.SIDE FT. FT. DESCRIPTION OFWORIC L.SIDI Fr. ..-------"-------- Fr. ALTERATION / ADDITION REAR FT. FT. DISTANCE BHT. BET.MAIN I MAIN BLDQS, ACCESS.BLDGS. REPAIR MOVING l PEEMOLISH - BUILDIN. ix L F ROOMS ✓ STORIES C.U.P.# APPROVED SIZE 3 c0 EXTERIOR WAL{.�/ / I ROOF O O WI eTPRQ ,ED VI DATE (� //-be COVERING YiIip" /1I C7OOVERING�/p( "� LV .f USE W ILDI}�S ANS'/ /O e�9 BE ER/I//A/✓ /I PV _ P. U OF (yn DI th SO.PT. '.13 G I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE j AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COY. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. R1 PLY WITH ALL CITY ORTu NCE ID STA WE REGULATING VALUATION eM P3 BUILDING CONSTRUCTION L PERMIT FEE 5 � O SIGNATURE OF G PERMITTER �." W s ?J/1 it PLAN CHECK $ AUTHORIZED AGENT p�U1`C� • .1{ . .... .. n .'..P:. :.. .. �... . .._..,,..-c..,.r__. .. \ TOTAL FEE $ .