HomeMy WebLinkAbout273 BROADWAY - Building Permitsi 10824A,
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 317 COSTA MESA.,CALIFORNIA
FOR APPLICANT T.0 f/LL /N COMPLETELY
TYPE
CALIFO
FEE RECEIVED'
FINANCE
ECEIVE®-
FINANGE Hpi
APFWaA(fi86TAcMt8AERMIT
'y /\ BUILDING
1/
fox Off/CE USE ONLY
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RECEIPT NO. PE R IT NO.
OWNER —
I
RECEI E BT
ISSUED
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AMAIL
DDRESS `
/DA
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TEL.
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BUILDING
CITY NO.
ADDRESS
ARCHITECT LIC.
COSTA MESA, CALIF RNIA
OR ENGINEER)ftNO.
FIRE
ADDRESS
ZONE
TYPE GROUP
STTE
APPROVED
//
CONTRACTOR _ LIA
C. NO.
BY
✓ / DATE 2
i
ONING
ADDRESS
LEGAL72
(LOT
I
I C
ZONE
NO.OF UBE OF NE
DESCRIPTION
NO.
BLOCK
T GY
PLANS BUILDING,
APPR
f
A.P. NO. •�
BV
DATE
SIZE ��(( V I'M..
;V
6
VARDS
I VES �'��•�%
OF LOT (
Now OLoi
N
REQUIRED
'LLOWED
USE OF
(CENTER LINE
.1
EXISTING BLDG.
FRONT
SETBACK LINE FROM
CENTER OF STREET REAR YARD
R. SIDE
IFT. IN.
r
ILEFT 1' t7
(RIGHT
SIDE YARD
L. SIDE
FT. IN.
DESCRIPTION OF WORK
i7
G
R/EAR
N.
I I II
NEW III ALTERATION ADDITION
I II I II
REPAIR MOVING DEMOLISH
BUILDING NO.OF
SIZE 'ROOMS STORIES
EXTERIOR WALL
(ROOF
'
COVERING
COVERING
USERF BUILDING AND WORK TO BE ERFO D
'
A
C
q F
¢'
I HEREBY ACKNOWLEDG THAT I HAVE READ THIS APPLICATION
THE AMOUNT KNOWN NOER VALUATION I8 FOR T
AND STATE THAT THE ABOVE IS CORRECT ANO AGREE TO COM-
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
PURPOSE OF
ESTABLISHING A PERMIT FEE ONLY.
BUILDING CONSTRUCTION.
VALUATION
SIGNATURE OF
PERMIT FEE $
PERMITTEE
PLAN CHECK $ 7, df
Q
$ / �O
f
IS^•
' -_n
AUTHORIZED AGENT
TOTAL FEE $
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