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HomeMy WebLinkAbout1862 PARK AVE - Building PermitsK; y.17b Gr_aa1Dl sDU COSTA MESA BUILDING -SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only BUILDING ray P `,/u ADDRESS d O !1r A.P. NO. �Z� BUILDING �Q zs� OWNER OR lT of dBQ A AWC64 4 TENANT ADDRESS UNIT OR MAILING �J ADDRESS �! (�J role Xza0 SPACE NO. TEL TR.NO. / LOT �r^f // BLK. �/ w�s CITY C&Is-.rX "f�c-ao NO.7 S NEW ADD ALTER REPAIR MOVING DEMOLISH CONSTRUCTION /s'T r C� LENDER BRANCH /r OWNER bri A ADDRESS VAL ARCHITECT TEL. S '�✓© OR ENGINEER r ADDRESS ZONE TYPE GROUP .�/ / f /?�e �� �z(/` APPROVED DATE ` d //Te CONTRACTOR 6.'(( Bf BY ADDRES e 41111,e440,oV4 A✓E TEL i/ s CITY Q� N 15Y STATE CITY APPROVED SETBACKS LIC. NO. J O LIC. NO. 3258 9 �G ZI SIZE No OFBLDGS. g (FROM C/L STREET) OF LOT NOW ON LOT l✓ FRONT FT. USE OF ��`� EXISTING BLDG. Separate permits are required for L. SIDE FT. electric, plumbing and heating work: REAR FT. USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION DATE {.� APPROVED I/ 1 /Z otoAPPROVED �C� C DATE l 1 hereby acknowledge that I have read this application and state P that the above information Is correct and agree to comply with all laws regulating building construction, and 1 shall not employ any person In violation of the workman's compensation laws of Q the State of California. I hereby certify that 1 em properly licensed as a contractor under SO. FT. m N the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS R D Chapter 9, and that such licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE O V: em exempt from the provisions of the State of Co)Itgrnie B mess VALUATION and Professions Cod e Iv:�iiss;oo/nn 3, Chap 9. r PERMIT FEE E Signature of ✓� `/`� �\ PLAN CHECK E Permittee 5�(f TAX E V U Authorized Ag nt Date TOTAL PAID E C /I