HomeMy WebLinkAbout2413 RICHMOND WAY - Building Permits eitESS a WADING: 2413 RICHMOND WY'rWit CITY OF COSTA MESA — BUILDING PERMIT
NAMEIE IOCYIN: MC DONALD, BRADFORD CROFT PERM NO: B 073610
ADDRESS: 2413 RICHMOND WY
COSTA MESA,CA 92626 PERMIT NO: B 073610 PLAN CHECK NO: N GOVT: N SUPP: N
APPL.MAIUNG ADDRESS CONSTRUCTION TYPE: VN PERMIT TYPE: STR PURPOSE: OTH
ARCHRECT OR ENGINEER: UO.NO.: JOB DESCRIPTION : T/OFF, SHEATH & REROOF W/ COMP SHINGLES SQ FT: 2, 999
NICK OR ENG.'S ADDRESS: LINT:
CLAIM VALUE: 2, 999 .00 CALC—VALUE: 2,999 .00 GROUP OCC: R-3 /
CONTRACTOR'SNAME: STOUT ROOFING INC ( 310) 923-6775
CONTRACTORSMAlUN0 P 0 BOX 4309 COMMENTS: SMOKE DETECTORS REQUIRED PER 91 UBC
ADDREss: DOWNEY CA MNG.: 402536 *****1Eiflfx-ifiEiE**********+E+EiE*1EiEiEitiflfiFSkiFiFifiEiEiEfElEitiEiE*******iEiElEifiEfEfE♦E1E****iEiE****iEiE♦Ert****
90241 LINT: Z ONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty 4 ...jury that I am licensed under provislo•-of Chapter B SETBACKS
(commenting with Section 7000)of Division 3 d the Business and Pmfeesio ,e,and my r.-nae is In full force r. act.
CITYLIC.NO.: 059 77 UC.CLASS: 39 UC.N. ' 025/. EX`, 10/9: MAIN BUILDING ACCESSORY BUILDING
---- L1�g RNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Date: / conrcaaor: i� ��� .�.e i.._a«�..✓ EFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penalty of perjury that I em exempt from the Contractors License /for the ,
folio g reason(Section 7031.5 Business and Professions Code:Any ay o county which requires a permit to construct,.;!,Improve,
demolish,«repai any structure,prior to hs issuance.also requires the applicant for such permit to file a signed statement I : he or she PARRHIf10c;kBQU• PROAdv : PARCEL: 41916559 ZNE: REF NO:
is licensed pursuant to the provisions of the Contractors License Law[Chapter 9(commenting with Section 7000)d Division 3 d the PLANNING NOTES>7
Business and Professions Code]or that he or she is exempt therefrom and the basis for the alleged exemption.My violation of Section
7031.5 by any applicant fora permit subjects the applicant to a civil penalty of not more than(Ile hundred dollars($SGOI. rt
*********************************************************************'dam*********
❑ I,as ovmer of the property or my empioyees with wages as theit sole compensdion,will do the work,and the structure is not intended D E V E'''L O P M E N T SERVICES REQUIREMENTS
or offered for sale(Section 7044.Business and Professions Code:The Contractors License Law does not apply to an owner of property 1+
who bolds or improves thereon,end who does such work himself or herse$or through his or her own employees,provided that such l ='e
improvements are rot intended or offered for sale.N.however,the building or improvement is sold within one year of completion,the ZONING APPROVED/ BY DATE: i' '
ownenbui der will have the burden of proving he or she did not build or improve for the purpose of sale).
❑ I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Businessrk a /) /
Professions Code:The Contractors License Law does not apply to an ownerproperty who buildsimproves thereon elw BUILDING APPROVED H Y : DATE: �'
of or and w
contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law). ,
❑ Iamexempt under Section: B.&P.C..for this reason: APPLICATION ISSUED BY: DATE: 2��/r�I
********************************** * *************************** . . . . . . . . • **
Date: LEGALIZATION:N FEE MMARY STRUCTURA S GMENT:Y
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and
25534.and that I or any tenure building o«upent will I will net(circle one)need to comply with said state codes end the requirements for
apemrh forconetmdon or modifcton from the Ai Quality Management District.Resldemialcondnraapplications are exempt fthese BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
provisions. PERMIT 54 . 00 . 50
Dale: Applicant: SMIP/NON—RES
PLAN
WORKER'S COMPENSATION DECLARATION:I hereby offing under penalty of perjury one of the following declarations: ISSUE FEE
❑ Ihave and witmaintain acertificate dconsenttoself-insure for workers'compenstion.as provided for by Semon 3703 of the Labor BUILDING PERMIT ISSUE PLAN—CHECK TOTAL PAID
code,for the performance d the wok for which this permit is issued. DUE
I have and wit maintain workers'compensation insurance.as required by Section 3700 of the Labor Code,for the performance of the TOTALS----> 54 . 50 0 .00 0 . 00 54 . 50 54 . 50 . 00
work for which This permit is issued.My workem'.00mpensaton insurance carrier and policy number are:
Carder: STATE EXPIRES REVENUE DIVISION TOTALS--> COLLECTED : 54 . 50 OVER/SHORT: •00
Pricy Number: 04494U000468 / 10/19/95 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—C$ECK
(This section need not be completed I the pend is for one hundred dollars 1$:001 or less.) 54 . 00 . 50
❑ I certify that in the performance of the work for which this permit is u I shall not employ any person in:.. manner as to
become subjed to the workers'compensation laws of Calfom' ree the'. I should became .
to the **************************************************************************dl***
com a pf provisions sea^37oo d�y Labor Code, ah rth�. pry; n moss provision
`�r / INDIVIDUAL F E E BREAKDOWN
Date: `f- /j •y �i Applicant:
Warning:Failure to secure workers'compensation coverage Is on:awful,and shell subject an employer to trim/ I penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL Cog T
cavil fines up to one hundred thousand dollars(slog00GA In addition to the cost of compensation,damages s provided for In
Section3706of the Labor Code,interest,and attorney's lees. SFR 2999 . REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 2 , 999,00
CONSTRUCTION LENDING AGENCY: I hereby affirm under penally of perjury that them is a construction lending agency for the END OF FEES
performance of the work for which this permit is issued(Section 3097.Civ.C).
LENDER'S NAME:
LENDER'S ADDRESS:
I certify that I have read this application and slate Mat the above information is correct.I agree to comply with all city and county ordinances
and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned properly
for inspection purposes.j!sR�L�ENjE� BURFORD Q��
L��//GC'N�u�— i ✓L al sal E: /04/951ST697IME TOT
09:27 54.50
F-,--,2r DATE: 0$/04195 TIME: 04:.7
ae.
Signature of Owner/Agent/Applicant/Con seri
(5151'46 WP) While-Building A Safely:Green-Fla:Caney-Applicant:Pink-Revenue:Goldenrod-Assessor -
rCONSTRUCTIONANDPLANNING . POOL & SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location r
2. Soil Pipe•Undrgrnd. "� 53. Steel Reinforcement -• '
;, 3 „Electrical Conduit Utility-Undrgrnd. 54. Forms
�4rE ectricaI Conduit-UFOrgrnd. - • - 55. Electrical Bonding i
r,E4S0t
eel Reinforceme >-
- 56. Rough Plumbing & Pressure Test -
1▪ =61_Eiectrical UFEA?hd. r - • - 57. APPROVAL TO COVER-GUNITE 'a
5 c' -
0
.t7-:,.)F-ootings sO - . 58. Electrical Condy1L-Undrgrnd. ,rt
- e8 Foundation - = E. 59. Gas Pipe, D Urfr)rarnd.,Test
9- t."Water Pipe-Undngr`rt i. ` - 60. Backwash Lines, RTrap, D=Undrgrnd. ;
1'-r
M. Structural Floor System • �, 61. APPROVAL TO DECK. - .
p. Property Sewer Line,& House:Connection 62. Backwash & Receptor-Final- - •
12. Sewer Cap 63. Heater & Vent-Final
•
13. Rool Drains _ 64. Plumbing System -Final .
14. Rough Plumbing=
•
PROJECTADDRESS:S NAME: MC 2413 WY
CROFT (,(3 0 UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: M Vb /359
' OwNEADDRESS: 2413 RICHMOND WY PERMIT NO: M 067354 PLAN CHECK NO: N (..5UV1 : N SUP[: N
COSTA MESA,CA 92626
CONSTRUCTION TYPE: V—N PERMIT TYPE: MEC PURPOSE: ADD
714 ) 641-4934
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : FACTORY FIRE PLACE " SEE COMMENTS •' SQ FT:
, ADDRESS: UNIT:
CLAIM VALUE: CALC—VALUE : GROUP OCC : R-3 /
PERMITTEE: OAK—LAND ( 909 )734-6665
ADDRESS: 480 BLAINE - COMMENTS : LAB TESTED # NER—QA403 & UL# MH8988
CORONA CA 91720 ****>Ey6TF***kF********x*SE** ,;*3F**yE+y**OF*rP********** -pF*ycTF**yE**pF****aEyF*yE****->F*** -*3E+SAP
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section - ZONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Corte and my license is in full force and effect SETBACKS
C STATE MC.:5283 •. n
2 MAIN BUILDING ACCESSORY BUILDING •
�oate• Signature: AL • FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
RKERS'COMPENSATI N DECLARATION: I hereby affirm that ave a certificate of consent to self-insure or a certificate of Workers' LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
Compensation Insurance,or a certified copy thereof(Section 3800, Lab.C).
POLICY NO.: EXP.DATE: PARKING REQ: PROV: PARCEL: 41916559 ZNE: REF NO: •
COMPANY: PLANNING NOTES>
0 Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. >
3************************************J******!E****************3*+E***************
Date: Applicant: DEVELOPMENT S E R „V I C E:•S REQUIREMENTS
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed it the permit is for one hundred(5100)or less).
( edify that in the perform nce of the work for which this per (shall n• alloys prop as to become �'t ' '
su lett to the N rkers' mpensation Laws of California. or ZONING APPROVED BY ,^ DATE :
1 411 tie
ate. ���e7 "l�I Signature: BUILDING APPROVED BY : K . i1 DATE:
NOTICE:If,after aking this declaration,you should beco a subject to the Workers'Compensation provisions of the Labor
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. e • W�(• d
CONSTRUCTION LENDING AGENCY: hereby affirm that There is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: �/ I �, ''-I DATE: "��s'.� - C t tie
' which this permit is issued(Section 3097,Civ.Cl ***********************************'**i/ 7 -. * - ****'*.-***'*'*' • "-'xr., 'r• N-
• LENDER: ******************************************* 1Af************************* {*******
ADDRESS: LEGALIZATION: N F E E S U MlM'A R Y, STRUCTURAL S -GMENT: N
OWNER BUILDER DECLARATION: Thereby affirm that am eeempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC \ ....fFIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT — ✓ 9 5 0� u
, repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed , 25% 1SM I P/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN 1
•1..-^and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by ,1
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE x 15 0
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
I. as owner of the properly or my employees with wages as their sole compensation, will do the work, and the TOTALS----> 9 • 50 15 . 00 00 0 , 00 -2 •- 50 24 . 50 • .00
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Cade: The Contractors'State License Law ‘‘a
v, r '
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through
his or her own employees,provided that such improvements are not intended or offered for sale. If,however the building or REVENUE DIVISION TOTALS--> COLLECTED• .7 ;4; J OVER/SHORT: .00
improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC 1' F I r •" "MIP/TOT TOT GRADING PLAN—CHECK
for the purpose of sale). - HECK
2.4 . 50
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business / / •4:' "t� '
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon ******************************************** *****.$e*_***************************
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware
that proof of their Worker's Compensation insurance should be provided to me. IND I V IDUAL - F'E E " B/IR 11E 'A K D O W N
❑ I am exempt under Section: B.8 P.C. ' T ' I
for this reason: TYPE QTY DESCRIPTIO N • . , --m'. UNIT COST TOTAL COST
,1
Date: Owner: MEC 1 GAS PIPING SYS 1 — 4 ,OUTLETS I 3 . 00 3 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and MEC 1 FACTORY FIREPLACE •.. - ,--• ;y/ 6 . 50 6 • 50
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a ENDr OF FEES i - - ,
permit for construction or modification from the Air Ouabty Management District.Residential construction applications are exempt from :H r 1 r Al
these provisions
Date: Applicant: i
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county /-
ordinances and state laws relating to building construction and hereby out •ie rein. •r .' 's of this cit to•• •thy:hove-mentioned ,y'
for ins tion Pur oses. �/ , - , 5 iA •
C •a //�� ' . " .: 01 00161262-00161262 TOT 24.50
lip
` S ?f�� Sig / / t 7 '.: DATE: 05/27/94 TIME: 09:44
Driver's License or Social Security p: /
1641-46 White—Building;Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit""r Date Inspector APPROVALS Permit Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Und grnd. 54. Forms '
4. Electrical Conduit-Undrgrrul._ 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 p - 59. Gas Pipe, 0 Undrgrnd„Test
9. Water Pipe-Undrgrnd. , 60. Backwash Lines,P-Trap, 1 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
r {
14. Rough Plumbing ', 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16.. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground HLdro
(
22. Ducts, Ventilating 71. Product Piping U Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
1
24 Roof Framing 73. Undergrnd.Storage Tank 0 Gas Oil
--1
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 PREY. FINAL I
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: 1
34 Final Heating& Air Conditioning _
/2-Z.Ke � --67/1- /VT 2te-191I- /,_ /
35. Final Gas Pipe-Test 4?1
36. Hood or Canopy- - --
37. Final Factory Fireplabe. q� r i,
(ZZ3 1�G !tris
38. Final Plumbing .'31-0_a_
�C� 0� Z 1 7-Va_
39. Water Service-Final
6=x=44 .__
40. Gas Service-Final
c_o� -
(.22234iFz_ = _-
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation •
-I
44. Landscape Irrigation System
45. Sound Attenuation j
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING -.
49. Electric Release to Edison -
50. Gas Release to Southern California Gas Co .
51. CERTIFICATE OF OCCUPANCY
No. Date
1 -
OWNER SAN VISTA BUILDING COMPANY DATE 6-1-64
JOB ADDRESS 2413 Richmond Way BUILDING PERMIT NO. 22274
GENERAL CONTRACTOR same VALUE $ 14,835.00
AP No. LOT 224 TRACT 5160 FIRE ZONE DESCRIPTION OF WORK res W :tt ar
. INSPECTIONS Signature DATE, GROUP JggJ TYPE V ZONE R3
Soil / P } SUBCONTRACTOR PERMITS ISSUED
Gas DATE NUMBER
Water
Rough Com. Refrig. 0 Air Cond. 0
Rough Heating /y-�/. '�� - 7/2 tZ/! 3 S& V —
Rough Plumbing 1/ - b 7 u'7 R, 4 ' . 2 —40,5/'_.5,— •-•i r/J 7- "").--
a--
, Miscellaneous
—j.-
Miscellaneous �
Prop. S . Line D House Con. VS-t. Swr. 0 - 6*/ c � (t
--L ',,.._,ti p:C 9 1963 40 7',71 ;
Sprinkling System 111
Construction Pole
Underground 0 Power 0
Rough Wiring/ / I '/ .-)01c . �
.; -/ SEP 1 7 1364 3 4 6 2 —
Trenches,[ ' Forms COY Steel Reinf. ❑
Floor System
Bond Beam 0 Steel Reinforce 0
Sheathing I A / ,
Frame and nlashi g i ' / �, ��
Lathing — In Out v Y4anNn9 D(I,
Plaster, brown coat e /7 - �_`
Refrig. 0 Air Con. 0 Final _- J 1.4,_
irna„;-
Heating, Final recd.
Plumbing Fixtures, Final G " _ v
FinalFinal Ga
Electric Fixtures, Final - 1 _err-
Building, Final Ii, :4/
OCCUPANCY 1 ,
Form BU4-6M-3-63—S-B P HOLD FOR SPEI.IAL REQUIREMENTS.
•
2227 FEE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 317 COSTA MESA,CALIFORNIA FINANCE DEPT.
For Applicant ro Fill In Completely APP4Qj 1I9 I MAWS
TYPE OR PRINT ��' ! BUILDING
BUILDING 9 /� .t ��%�C^-/vYH'Gf/9 r For Office Use Only
ADDRESS o�
RECEIPT NO.
COSTA MESA. CALIFORNIA 2RRyy 727 Q
•
R[CE V BY DATE RECEIVED JBAYE IBRUEAsa
T A^ // UU 11 ``�J
OWNER'SQev` �� `t- �`I (tit) •
MAIL I f t _ I (O cal
11(". f ADDRESS
ADDRESS 14
`QY�7 in c l CJ s� lam,_`
V ' J n (� FIRE f T'S
CITY r 1 ( � � N��J/�7�Q! ZONE TYPE GROUP
'alAPPROVED
ARCHITECT �T/�� TEL.O/q� BY DATE
OR ENGINEER p�LrvDL✓�6-¢_- NQ. �•]Q /a0
' / /(��� }-y_ll ZONING
�,,�f�/ — f I yt •
ADDRESS 432- (Jl�� �^yV^..,�..,� �(�1`�1�� - �1� _■�ealli SL i :r
CONTRACTOR ,QQM UL n- OXc( &I
T, ` GAL r ' /6541.1a
!
( / `�-p LN 1 DESCRIPTION r fV�/ r
ADDRESS 4 1 ((de �• r •
CITY ti/ Qf• // A.P.NO. IC'l�"
'
/ \lj
NOTE: NO EAVE OVERHANG SHALL BE LE V.THAN
STATE (L TEl /�/� 7j Q. 30"TO SIDE a REAR P.L.
EAVES
LIC.NO.�� 27 �i NO./7/J�/�Q
SIZE ^ /� ,l NO.OF BLOCS. ALLOWED - (U.B.C.REQUIREMENT/
OF LOT 2O J( / U -NOW ON LOT YARDS APPROVED YARDS APPROVED p•�/
USE OF Q� „';• A MAIN BUILDING ACCESSORY BUILDING\. Z•
EXISTING BLDG. i �7 /
(FROM C/L ITREET)
SETBACK LINK FROM ) FRONT C FT. 'FT.
CENTER OF STREET 3 REAR YARD CD
SIDE YARD I LEFT 0 I RIGHT' C , R.SIDE 0 FT. . FT- -
• DESCRIPTION OF WORK • L.SIDE CFT. Fr. K
NEW • k ALTERATION ADDITION REAR Q FT. FT. '
DISTANCE BET. BET.MAIN Q
•
REPAIR MOVING DEMOLISH MAIN SLOGS. ACCESS.BLDGS. e•
in
BUILDING nn NO.OP /Fit"a 3 y VAR.# DATE IZ
SIZE OC O X 3 ZROOMS sl STORIES a C.U.P. APPROVED
EXTERIOR WAL I ROVE _Q_ jrRO\ 1IxwA#c
EXT E IOR COVERING L DATE •.✓ / Q$
USEQF BUILD G AND WORK TO B ERFORMEeIl
P .
(I)A-•
•
/ ac
— -kW FT. —442,0 o a
.•
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN ER VALUATION IS FOR THE S
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABL1 INC A PERMIT FEE ONLY. O
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION '
yq ✓. ��//
BUILDING CONS RUCTION. P
ERMIT FEE $ LiJ• v V j -.
SIGNATURE OF
PERMITTEF ��� /� / �• G, '�1 G
$ 3N,L/VEC1244 IrO re
o
re
AUTHORIZED A _ ///����7
A. a TOTAL FEE $ /O{• 0
/ S