HomeMy WebLinkAbout2633 HARBOR BLVD - Building Permits_' 527_. / 17Ni
ADDRESS a SLALOM: 2633 HARBOR EL DIT' CITY OF COSTA MESA - BUILDING PERMIT
OWNERS NAME IF MOWN: COAST TO COAST WIRELESS PERM NO: B 086639
ADDREss: 2633 HARBOR EL
a, COSTA MESA,CA 92626 PERMIT NO: B 086639 PLAN CHECK NO: 00238-98 S GOVT: N SUPP : N
) 429-9800
APDL.MAILING ADORES& CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: OTH
ARSANECT OREIIGNEER: B C ADAMS uCNO.: C10183 JOB DESCRIPTION : INSTALL AWNING IN FRONT OF BUILDING SQ FT: 4, 500
ARMOR ENG.'S ADDRESS: 11022 ACACIA PKWY DIT: E
G.G. CA 92640 CLAIM VALUE: 4 , 500 . 00 CALC-VALUE: 4 , 500 . 00 GROUP OCC: B /
CONTRACTOR'S NAME:B AND C AWNINGS ( 714 ) 632-3303
CONTRACTOR'S MAIUNG 1005 S ORTEGA WY COMMENTS : INSTALL AWNING
ADORES& PLACENTIA CA uc.ND.: 580921 *****************sE**)Esc**** x**Ss*st*+t*+t+ ***:E**x**srst******St************)E:E** *#st***
92760 WIT: ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 SE T B ACK S
(commenting with Section 7000)of Division 3 of the Business end Professions Code,and my license is in full force and effect.
crrYuc.NO.:064466 UC.CLASS: C—6 1 uC.NO.: 580921 EXP : 00/00 MAIN BUILDING ACCESSORY BUILDING
----, pate: Contractor: FRNT: 57 FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
% LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penally of perjury that I am exempt from the Contractors License Law for the
following reason(section 7031.5 Business and Professions Code:Any city or aumy which requires a permit lo construct,atter.improve, PARKING REQ: P RO V• PARCEL: 13936207 Z N E• CI REF NO:
demolish,or repel any structure,polo to is issuance.also requires the applicant for ouch permit to file a signed statement that he or she
isl emedpmsuenuotheprovisbmdrheConuadorsUcenseLawIChapw9(oommendrgwhhSeaion7000)dDviion3ofthe PLANNING NOTES> INSTALL AWNING ON AN EXISTING COMMERCIAL BUILDING - 57 ' LONG
31. and Professions Code]or that he or she is exempt therefrom and the basis for the alleged exemption.My violation of Section > AND 4 ' HIGH. SIGN COPY ON SEPARATE PERMIT.
5 by any applicant apermh subjects the applicant to a civil of not than live hundred dollarslS500D. ********j(.**.****.N,***************** ******.7E******j(.*7!******jt.********)F*N.*****-)E*.N.***
O I.as owner of the property or my employees with wages as their sole compensation,will do the work,and the structure is not intended D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
or offered ler sale(Section 7044,Business end Professions Code:The Contractors License Law don not applyto a owner o wovenwop
who buids or improves thereon,end who does such work himself or herself or through hi or her own employees,provided that such
improvements are not intended or offered for sale.If,however,the building or inprovemem is sold within one year of completion,the ZONING APPROVED BY W`(�
is.- DATE: ( 1 '/0 1 m
owner-buikler will have the burden of proving he or she did not build or improve for the purpose of sale).
❑ I,as owner of the properly,am exclusively contracting with licensed contractors to construct the project(Section 7044.Business and
Profession Code:The Contractors License Law does not appy to an owner d properly who builds or improves thereon and who BUILDING APPROVED BY : DATE:
contracts(or such projects with a Grma.t'or(s) tensed pursuant to the Contractors License Law). �- (.)
❑ I am exempt under Section: B.&P.C.,for this reason: APPLICATION ISSUED BY : DATE: `,L.G(
Date: owner: ******************************************** * *******************************
LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
I do hereby certify thatI sin aware of and understand the requirements of California Health n Ne ,and Safety Code Sectio25505,25533,and
PxtM,and that I or any future building occupant will/wit not(circle one)need to comply wih said state codes end the requirements for
a permit for construction or modification from the Ai Quality Management DistrictResidemkJ construction applications are exempt these ree BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
provisions. PERMIT 99 . 75
Date: Applicant: SMIP/NON-RES
WORKERS COMPENSATION DECLARATION:I hereby affirmunder penety of perjury one of the following declarations: PLAN 64 . 84 . 95
❑ I have and will maintain aceniiicafe of consent to self--insure for worker'compensatoo n.as provided for Section 3700 the Labor ISSUE FEE
Code.for the performance of the work for which this permit i Issued.
BUILDING DIV > PERMIT ISSUE PLAN CHECK TOTAL PAID DUE
❑ Ihave 4,ew:lmaintanSection TOTALS > 100 . 70 0 . 00 64 . 84 165 . 54 165 . 54 . 00
work for which this permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier: REVENUE DIVISION TOTALS--> COLLECTED : 165 . 54 OVER/SHORT: .00
Policy Number BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
as section need not ore completed i the penmr is for one hundred dollars 13100Jor in.) 99 . 75 . 95 64 . 84
v<I certify that in the performance of the work for which this permit is issued,I&leu any person in any manner so as to
become subject to the workers'oomPavation laws of California,arts become subject to the w rker' *******************************************************************************
compensation provisions of section 3700 o the Labor Code,I shall .. �- provisions.
/ :% �'' INDIVIDUAL F E E BREAKDOWN
Date: 1/2,101 d7 Applicant i
Warning;Failure to*scum workers'compensation coverage Is unlawful,and she subject an employer to criminal penalties and TYPE QTY . DESCRIPTIO N UNIT COST TOTAL COST
civil ansa up to one hundred thousand dollars(Jt00,000f,In add/don to the cwt of compensation,damages as provided for In
Section 3706 of the Labor Cods,Interest,andaffomey's fes. SFC 4500 ALTER BY VALUE COMMERCIAL NOZONE 1 . 00 4 , 500 . 00
CONSTRUCTION LENDING AGENCY;I hereby affirm under penalty of perjury that there is a construction lending agency for the END OF FEES
performance of the work for which this permit is issued(Seaon 3097,Ch.C).
LENDER'S NAME:
LENDER'S ADDRESS:
I certify that I have read this application and stele that the above information is coned.I agree to comply with all city end county ordinances
and stare taws relating to building construction and hereby authorize representatives of this sty to enter upon the abore.medioned property f ED
for inspection purposes.
MATT WALKER {,'p7,n*] {.�r_1''
Lama g 81-28-1998/18:12 RM/$165.54
iJ RCPT8:81-8918383
y Date L/�A77CI DA'PE--�. PERP9IT:B86639.
signature of Omer/Agent/ApplcantrContrector
a
(5151-46 W P) White-Building&Safety;Green-File;Canary-Applicant;Pink-Revenue;Goldenrod-Assessor
r
4-- POOL I. A
CONSTertCTION AND PLANNINIG ' -y
APPROVALS . Permit# 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-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. - 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL-TO COVER-GUNITE
7. Footings • 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System .61. APPROVAL TO DECK
T1. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
I
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
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
I .
20. Rough Factory'F 1 - APPROVALS - Permit #
21. Ducts,in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas 0 Oil -
23. Gas Pipe-Rough& Test 72. Underground Flush
24. Roof Framing - ' , 73. Undergrnd.Storage Tank 0 Gas 0 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 PREY. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION01 P
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED .
33. FinalElectric Notes:
1
34. Final Heating &Air Conditioning - • j
e
35. Final Gas Pipe-Testt
36. Hood or Canopy "' �j
37. Final Factory Fireplace - - �!-
38. Final Plumbing -
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation .. - -
44. Landscape Irrigation System - - -
45. Sound Attenuationrt'
• .•n cel
46. Handicap Regulations I
.
' 47. FINAL STRUCTURE & BUILDING 3 c
48. FINAL PLANNING -
49. Electric Release to Edison _
50. Gas Release to Southern California Gas Co .
51. CERTIFICATE OF OCCUPANCY
No. Date
,i
ADDRESS a WWW: 2633 HARBOR BL wit CITY OF COSTA MESA - SIGN PERMITS
' 48 -ooc9 /7
CWNER9NAMEIFKNOWN:COAST TO COAST WIRELESS
/ PERM NO: SB 086640
Aomiss: 2633 HARBOR BL
COSTA MESA,CA 92626 PERMIT NO: SB 086640 PLAN CHECK NO: 00239-98 N GOVT: N SUPP : N
429-9800
OK.IMMO ADDRESS: CONSTRUCTION TYPE: PERMIT TYPE : STR SIG PURPOSE: OTH
ARCHITECT OR ENGINEER: 11C.N0_ JOB DESCRIPTION : INSTALL SIGN ON NEW AWNING SQ FT:
ARCH.OR END'S ADDRESS: UNI:
CLAIM VALUE: 500 . 00 CALC-VALUE: 500 . 00 GROUP OCC : B /
coNTRAc)0lrs we:B AND C AWNINGS ( 714 ) 632-3303
cannegoRS IMPS 1005 S ORTEGA WY COMMENTS : INSTALL SIGN ON AWNING, #886639, "NEXTEL-COAST TO COAST WIRELESS"
mins: PLACENTIA CA UC N0. 580921 ***********♦ESE*3Eif*lf*if-3F**+F*iF3ElE1f1E1E***********tE3 ****1f****iF****iF****itE+t-1tiFRfif+E****aEiE***
92760 um. SIGN INFORMATIO N
LICENSED CONTRACTORS DECLARATION:I hereby Slim under penalty d perjurythat Ism eeeaed under emeticrad Chapter9 DISTRICT: 1 TYPE: AWNING ILLUMINATION: NON CATEGORY: NEW
(commencing*eh Section7 O)dD.i.4n3dtheBusneerandProfe.:onsCode.andmylicense ' mforce end Sled. DIMENSIONS ; 57FT 00IN X 4FT 00IN AREA: 93 .00SQFT LETTER HT: 24
CITY LIC.NO.:064466 uc.cLAss: C-61 uc.No.: 58 STREET FRONTAGE 1 : 105 . 00 STREET 1 : HARBOR BL
Date: 1/ 112/11/ unmoor, STREET FRONTAGE 2 : 0 . 00 STREET 2 :
PARCEL : 13936207 ZONE: Cl LOCATION > FRONT: X REAR:
OWNER BUILDER DECLARATION:I hereby affirm uderpenely of pevJythatl em exempt from the ContMmLimnee Lav ler the BUSINESS NAME: COAST TO COAST > LEFT: RIGHT:
IMmiN reason(section TODIS Bus/less and Professions Cad:Any ov a Caney midi reabes a permit m consents,ma•improve. OTHER T OTALS GROUND SIGN
..mdeh•or repair ansnucuve.prim lo 'nouns.also requiem the spiral for weltperm*to Be n signed statement that he or she THIS ACTIVITY 93 . 00SQFT OVERALL HEIGHT: OFT OIN
a licensed pursuant to the provisions al the Catrrdon lineae Law(Chenix (commencing(caamenN withTo
h Section on)d Diveion 3 of the
Dueness and Professions Code(or hat he or she is exempt Urdranard the bsmtor theateged exemption.Anyvdeson of Section THIS SITE 1 . 00SQFT GROUND CLEARANCE: OFT OIN
7031.5 by any ariiad w
lot eNde he sporran m a cid penury dd remore than five hundred rima.j$5001). ITEMS OF INFO 1 PLANTER AREA: 0 . 00SQFT
CII,asowwar aRhprop.bormyendow"haw,""11"S°"ffiensffiffin."11d°"a'aek and Msuudneird:awded ITEMS FOR ACTIVITY : 1 BLDG SET BACK: 6OFT
vvor offered for.1,tads or msprov theSectien reon.andel wnBusinessdo Psdwas�msatahe .The % r*Troup he a wherowwn�employees. otth COPY VERBIAGE "REX TEL AUTHORIZED REPRESENTATIVE" - 2X; "COAST TO COAST
improvements are not wended or dieted for sale.N.however.the battling or inpraernw is sold within one yea of completion.he WIRELESS" - 1X ; PHONE # + CELL PHONE LOGO
ownerbolderwu have the burden d proving heor she did not bud or improve for the purpose d me). PLANNING NOTES:
❑ I.as owner dile property.amexdmdy oortradYN with kerns masa.be mnsnn the min(Sedio°)ou.Salina.and *******************************************************************************
Professions Code:The Contractors Lieaae Lew does not apply to an°wear d property who bub or improves thereon and aro
.tads for such prajeds with a oatrador(s)licensed www to the Contractors License Law). DEVELOPMENT SERVICES REQUIREMENTS
❑ I am exempt wider Section: B.A P.C..for this reason: I
ZONING APPROVED BY CV 9A- DATE: ( 215 111
Dae: Owner:
I do hereby oar*dad l am awn of ed aider.Wdt ereq.k °er"dCalk,'"Heals sed sehry Co"Sediau 25505.25533,eld BUILDING APPROVED BY : DATE:
25534,and that I a any hamtubing occupant will/wit not(acts one) Kat*co
need to comply will slid ts de.and the regWane is la
a perms la construction or mcdgration from the Ar tyy Mananplsra District Residential constriction applatioro are exempt from these APPLICATION ISSUED BY: - DATE: 1 `�X
aovisb^e.
Dna: MPTrant: **************************************************** **************** ********
LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
WORKER'S COMPENSATION DECLARATION:I hereby Nva Wderpennnyd Prjry csSaws fmainidedaabm: BLDG PMT PLUMBING ELECTRIC MECHANIC SIGN SMIP/RES GRADING
❑ IMVO and oil memenacen1Itons. r°'consent to sollensurs he workers'compenstilion.as Prodded far gsadan3700dthe Usher PERMIT 21 . 00
Code.for the performance of the work for Mich this camel is issued.
o Ihaveand wig meintanTD
ch hworkers'compensation insurance,as required by Section Do d he Labor Code.la the performance d the SMZP/NON RES
work for which perm*ls issued.My workers'compenseinn insurance canter and PAM,number are: PLAN . 50
Coma: ISSUE FEE
Policy Number: BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
nor TOTALS----> 21 . 50 0 . 00 0 . 00 21 . 50 21 . 50 . 00
I candy that in the ped°masa of the work for whish this permit is Issued.I any person In any manner so as to
c°°imp* j'affirh�prw "ffiari Section e` Tao'a the Labor cd°dC.•I°htlerMwfl ^^ -• /• ,.. bma°.�lrne aubt'd tothe work°" REVENUE DIVISION TOTALS--> COLLECTED: 21 . 50 OVER/SHORT: 00
A� �%%Cy BLDG PMT PLUMBING ELECTRIC MECHANIC SIGN SMIP/TOT GRADING PLAN-CHECK
Date: /7t072d 21 . 00 . 50
Warning:line up
to n.sun w thou compensation coverage Is a don t and shall end/sl anen employer to es s ppaaNu and
civil lines rpnonaNadrM fheussM dd4n(JIW,WO),6raddylbnmtla cosy otrompanesWM1 daneg..esprovkMd brin *******************************************************************************
Section 3706 of he Labor Coot Inland,and attorney's lies. INDIVIDUAL F E E B R E A K D O' W N
CONSTRUCTION LENDING AGENCY: I hereby affirm under penally of perjury that then is a construction lending agency for the
performance d the work for which this Fermi i.issued(Sedmo 3097.Cir.C). TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
LENDER'S NAME:
LENDER'S ADDRESS: NO FEES WERE SELECTED FOR THIS PERMIT
I certify that I have read this application and date that the above'Somalian is cornu.I agree lo comply with at city and county ordinances
and sate laws relating to bdMiy costa n ed herebystab*representatives of the dry to enter upon the above'matuned property
for inspection PerPoses.MATT WALKER Exp ID
111 81-28-1998/16:11 AK/$21.58
Na. NU
PERI'IITPT986G140
Date: I/zv�4Y RATS �3 �� lit
ugnatun d OwrMAgaWApp cerdX ahtacta it
(St S1de.WP) White-Budde A Safey:Green-Fide:Caffery-Appian:Pink-Berate:(bMraod- s,eesor
CONSTRUCTION AND PLANNING - PG, . & SPA
APPROVALS Permit# 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 UtilityUndrgrnb. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical LIFER Grnd. 57. APPROVAL TO COVER•GUNITE
7. Footings 58. Electrical Conduit•Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 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
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 Hydro
22. Ducts, Ventilating 71. Product Piping OGas ❑Oil
23. Gas Pipe-Rough&Test • 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74: Overhead Hydro
26. T•Bar Ceiling (Structurall & 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 i
40. Gas Service-Final - Y
_, c Solar Domestic-Final - -
•
42. Backflow Preventer
43. Backflow irrigation
44. Landscape Irrigation System -
45. Sound Attenuation - =>
46. Handicap Regulations
47. FINAL STRUCTURE& BUILDING "+
48. FINAL PLANNING ;
49. Electric Release to Edison ' :O4
.
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
1a233 FLE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT OV 2 1960
P. O. BOX 317 COSTA MESA. CALIFORNIA
FINANCE DEPT.
For Applicant to Fill In Completely APPLICATION FO9ITREIORIEOSTA MESA
)6.1ry TYPE OR PRINT
'.'.��//�� //�� BUILDING
BUILDING / / *hit/I MK
ADDRESS
COSTA MESA.LC�ALIFOR/N�IA/gyFor Office Use Only
PERMIT NO.
OWNERIO SFERH f•S(/l0w Peep I RECEIPT NO. I a.,?
MAIL ,1 / Imp�) tr RECEIVED BY DATE RECEIVED DATE ISSUED
ADDRESSI�O ��'/ H/r/`✓o, sapp• // /7' '" 6O I //c '
CITYC OS/� �j/Es/f NO i'7C317 ADDRESS
ARCHITECT TEL. COSTA MESA. CALIFORNIA
OR ENGINEER NO.
ADDRESS FIRE
�(
ZONE TYPE GROUP
CONTRACTOR Nr 0t"/ EN rare PR/SF APPROVED ��//�}.
''// +� 7< y/.. BY C%� DATE/// /G O .
ADDRESS720 d/S S / ' Z NING
.(� /A� /- ZON/E� NO.OP /� US8 OP NHW r
CITY /V�W PO/Z '/A✓/.' c 4 g / PLANE / I BUILDING s n`
LIC.TNO.Cs qc/a0S./ NO. OR- d d 2/ 0 LEGAL- �/'•
/ DESCRIPTION
SIZE I NO. OP BUDGE. Ley' /�
OF LOT NOW ON LOT A.P.NO / / 3- I V ,, --- L/7
USE OF YARDS EVES
EXISTING BLDG, APPROVED ALLOWED
SETBACK LINE FROM (CENTER LINE ST.)
CENTER OF STREET REAR YARD FRONT (.../--�/FJT. IN.
SIDE YARD I LEFT I RIGHT R.SIDE . /✓.(J PT. IN.
DESCRIPTION OF WORK ',,Ih�//11/
L.SIDE �v/vt•T. IN.
NEW I II ALTERATION I II ADDITION I REAR ,'�J/// EFT. / IN./ �,
tn
REPAIR I II MOVING I II DEMOLISH I APPROVED /�J�X / I DATE /� -(y a 1`
BUILDING NO. OF • 6 1 I)
SIZE ROOMS STORIES
EXTERIOR WALL I ROOF --"4�
COVERING COVERING
USE OF BUILDING AND WORK TO BE PERFORMED
1/411
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORKS AND AGREE TO COM.
PLY WITH ALL CITY ORDINANCES AND ATE S REGULATING PURPOSE OP �eTABLISHINO A PERMIT PSE ONLY. /''�
BUILDING CONE IIpTION. Cy Mir VALUATION �I Q"\
SIGNATURE OF �y/ L/� �" ' PERMIT FEE $ \1•Y•
PERMITTEE / C� r/�/I7'1�� i
$I/ U(JPLAN CHECK $
X
AUTHORIZED AGENT y �-O E �,-
Is'TOTAL FEE $ "5 � O 4--