HomeMy WebLinkAbout2156 RURAL PL - Building PermitsWir Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA M $A��//CON RUCTION MIT PEERMMIT NO. 1 TRACT NO. LOT O. UNIT NO.
- Project-Address CZ, (i/trj�G' � i' �� 1 I
Applicant's MailingAddress
u�SSS' ``/4 • / /// +� TYPE OF CONSTRUCTION U NEW DD U ALTERATION LI REPAIR
/ A. • /� Phone /AYh 7geP2 CI CONVERSION El DEMOLISH III OTHER _ A.P.# y s Jo - I as - 33 Zone Q�
Owner's Name DESCRIPTION OF WORK/USE •F BLDG. aCle a •ex 7 5
Address 2�Set / / r i •. _ S Main Building: Accessory Building:
Arch/Eng. ' License No. TYPE : PERMI In GRADING S FOUNDATION ❑ STRUCTURAL T Front ell TfICUED O
Address III TENANT El ELECTRICAL LI PLUMBING Ell MECHANICAL BRear 7,51N
❑ OTHER A
Contractor's Name ir3 •"-" Phone •• �� C Right 9 I ' 2 N
PROJECT DESCRIPTION .SO. FT. OCCUPANCY G
Address(mailing/ CON ST RUCTION TYPE V/v - VALUATION$ 1� T. • so $ Left 5 ' R
City License No. ZONE GRADING CU.YDS. ACRES
LICENSED,4CNT7 CLARATION Q Ping. Ref. # De_gjb- I S Parking Req./Provided a/02 E
I hereby artlrm lhatfl am lie rrovislons of Charter 9 (commencing Remarks: '��'/7.• / / �g n / / Pla nolo NOt¢5: / ,.. Q
with section 7000) of Division 3 of the Bo ess and Professions Code, and / `yy 7_ S ree A.e 03 P 4a!-Sr4� g ' add. ���SAY a� M
my license is in lull force end•ef feet. . TC 9'1 I B 1 I��.. [ Y Cl.� a _
License Class T
I s.r - License No. - 7 7. 75 qi & 1 S
Date ( Signature FLA._
FEES , HOLD FOR SPUTAL r .QUI' Obi / • �' cm
�r ORKERS'COMPEN SATION=DECLARATION Bar Sink Showers ELECTRICAL FEES '
60 :ereby affirm thatil have a certificate of consent to self-Insure or a certificate
of Workers' Compensationtlnsurance or a certified copy thereof (Sectl Backflow Preventer Service Sink
3800, Lab. C.p!1 - f her �(J Automatic Washer Transformer 0 15-50 KW
Policy No. �J � �"Company�4 Backflow Irrigation Sewer Cap Construction Pole Sub. - 0 50+ KW
Certified copy ishereby;urnished.
rtifi-d cfp Iled With the city S. /eivislon. • Bathttibs Sewer Connection Cooking Unit Meter ❑up to 100 amps
Date J Applicant 'a-.-/�J-� �_ ` — ,�/
EXEM iO FROM WORKERS'COMPENSATION Done•R•• ION Clarifiers Solar Col ors s— Dishwasher I Meter LYover 100 amps
(This section need n t be completed if the permit is for one hu dred ($100)or-.
r rl{t{ 1 7 ,SV
less). •� Dishwasher Solar Pi ln9 Dryers ❑Gas ❑Electric Sub Panel
I cetify that in the performance 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 Drinking ount Solar Ta k Fan Motors❑0-1 HP ❑1'/x-8
Workers' Compensation Laws of California. �_ _ _
Date �"` Signatl>Jb Floor grains Swimmit of w/Spa F.A.U.
NOTICE:If,after making this declaration,you should become subject to the Inc.Solar ❑g-15 HP ❑16-15+
Workers' Compensation provisions of the Labor Code, you must forthwith FIO• Sinks U I Fix res Microwave
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY , ,
re
Boxes Service Outlets Water C set Boxes Pole Light
. I hereby affirm that there Is a construction lending agency for the performance
of the work for which this permit is issued (Section 3097 Civ. C.) In erceptors / Water Hater /f_' 29Utlets Range
Lender's Name
Lender's Address Ki hen Sink Water Sir.- )1Pr Switches Sign 'o•
OWNER BUILDER DECLARATION 9 �"/
I hereby affirm that I am exempt from the Contractor's License Law for the Lava • les - • o-W:sh Garbage Disposal Standing Sections
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundr Trays Generator 00-5 KW 05.15 KW
any structure, prior to its issuance, also requires the applicant for such permit Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of —
Roof Drains
-e Contractor's License Law(Chapter 9 (commencing with Section 7000)of
vision 3 of the Business and Professions Code) or that he/she is exempt
' aerefrom 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
doe alty of not more than five hundred dollars($500).
7•;J I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee $ 3 Pr pensation, will do the work, and the structure is not intended or offered -I
- - Reinspection Fee I $15 Issue Fee $'S, 00
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES —
License Law 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 DEVELOPMENT SERVICES REQUIRE TS -/� d p
employees, provided that such improvements are not intended or offered for Boiler Hood os Type I 0 e L(/y eti (�0
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 Zoning Approved By Date
pletion, the owner will have the burden of proving he/she did not build or Im- Duct-Under Ground Building Approved By / Date _
prove for the purpose of sale). el‘
❑ I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By / Date 1---8--is
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 0o-100,000 BTU ❑100,000 BTU SUMMARY OF FEES
builds or improves thereon,and who contracts for such projects with a con-
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple ❑ System Repair/Alteration BUILDING PERMIT $ l 7,.5;60 SMIP $
proof o their Worker's Compensation in ur.nce should be provided to me. - PLAN CHECK $ '' PERMIT
❑ i am exempt� � underSection j'/- B. : P. ..for this reaso/ Firepl/Fact.Blt. ICBG 4 Fire Dampers ..-
I
ISSUANCE $
I PLUMBING $
Date Owner" . Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify that have rea• this application and ate that the .bove 1 0.100,000 BTU 0100,000 BTL A �� ELECTRICAL $ 72s7C GRADING $
information is correct. I agree to comply with all city and county ordinances L
and state laws relatin• to building constr ction,and here!, authorize repre- PLAN CHECK 50% $ �..� • �g MICROFILM $
sentatives of this o enter up• e above-men ed property ;.0),
inspection purp• .. ?frt / 3 MECHANICAL $ SIX•sO !�0.3 e
`-Signature i/. - Date U/` TOTAL FEE $
Drivers' License or SS# 71
` —�' Reinspection Fee I $15 Issue Fee $.3-- PLAN CHECK 25% $ �-`sir
CMF 0865-46,rev. 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor DA UOY J9/08/82U1lutSiTIME I U I LOS.!t
DATE: 09/08/88 TIME: 1h:03
"CONSTRUCTION AND PLANNING 4' POOL& SPA ,
Date ,Inspector Date Inspector
APPROVALS ' Permit# APPROVALS Permit#
1-. Temporary Electrical Service or Pole 52. Pool & Equipment Location •
21. 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 UFER Grnd. 57. APPROVAL TO COVER-GUNITE
'7. Footings • 58. Electrical Conduit-Undrgrnd.
'8.'Foundation ' • 59. Gas Pipe, 0 UndrgrndTest
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 `.4/ 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# 'r' -V
21. Ducts, in Structure / - 70. Underground Hydro
22. Ducts, Ventilating ---.,, 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough& Test 72. Underground Flush •
24. Roof Framing • '
/ 73. Undergrnd-Storage Tank:LIGas 0Oil
25. Roof Sheathing' - ' -74. Overhead Hydro ----'
26. T-Bar Ceiling (Structural) & Monocoat / ' 75. Dry Chemical `, .4'
27. Frame and Flashing �f , 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.i FINAL INSPECTION -- -
L 1
32. Electrical Power Meter-Final • 80. FOOD CERTIFICATE ISSUED
33. Final Electric " Notes: HOLD FOR SPECIAL REQUIREMENTS r ,•'„'1.
34. Final Heating & Air Conditioning `e-//.9/4>I -- /S. JX
j
35. Final Gas Pipe-Test U - :•1
36. Hood or Canopy • - • -
37. Final Factory Fireplace ,
38. Final Plumbing
39. Water Service-Final
•J •
40. Gas Se'ryice-Final -
i • - �/ ,
, 41. Solar Domestic-Final '
42. Backflow Preventer J
43. Backflow Irrigation '
•.44. Landscape Irrigation System (' j
f
145. Sound Attenuation ' i EXPIRED •
X46. Handicap Regulations Inc mplete Inspections
47. FINAL STRUCTURE & BUILDING • ;
Date
�6
48. Special Requirements Completed `f i
49. Electric Release to Edison ) , •
50. Gas Release to Southern California Gas Co i - - - ' {
t: . '
51. CERTIFICATE OF OCCUPANCY •
- No. Date ,. - --_,.
` ` -
i
• COUNTY OF ORANGE • ". /7
BUILDING DEPT. Permit No. �(�y�` �---
636 No. Broadway Application for Building Permit
Santa Ana, California
Phone: KI 2-6211 AND FOR A
Certificate of Use and Occupancy7-2e)) � �y
Date �P_/ d
I. OWNER'S NAME S/ i .,.. /.2r-)2-4,-,---2., �-/�-- PHONE: �jl Z 3 i
MAILING ADDRESS...78i r�0 3 3 CITY
1 0Q-C�--�l6.4-.Ci
Name .. _difo i Name.___7) „/9LL�4_0 e 4 "`�--...
� � ^ (Amor'E inee_) v� � (Contractor)
Address 1l2Y JZGti�`-�r'.f Address ._LZ�--�---- - -�-
6.
City i-rtra( (/�]-L d' City -.L
State State •////
• Lic. No. Phone Lic. No. -- Phone--14-- -/ 2 Z 31
• PROPOSED USE: �Gg_.2c' -4.._:_%.c-. 14-,-��7 Y'
C.
2. JOB LOCATION 2 I s Ca .a.k. T-Q_a.a C /
(House No.) (Name of Street) (Town or School District)
3. LEGAL DESCRIPTION: Lot / / Block Tract / 6
(Metes and Bounds Description—Use reserse side of form) •
4. CORNER LOT ( ) INTERIOR LOT ( a/ ) THROUGH LOT ( ) SLOPE OF LOT ( 6 ')
-VC . lo66
5. SIZE OF BLDG.: _6.0...X 3..3 AREA• C• .3 Sa SIZE OF LOT:_ FOX.97 AREA: 9.2--e9to
t co-‘4,,,, l 4 S t t
6. HEIGHT OF BLDG • / / CEILING HEIGHT- 7 / NO. OF STORIEES • I
7. NO. FAMILIES / Size of Smallest Bedroom:' o o Size of Kitchen: 70
8. EXTERIOR WALL CONSTRUCTION:__7.44004-e--- INTERIOR WALL COVERING .
(Frame, Stucco, Etc.) • (Plaster-Drywall, Etc.) .
- 9. SETBACKS: Front Yardssfrom Center Line of Street
_c ‘- 0 '
Nearest Side Yard ✓ Rear Yard Distance in Feet Between Bldgs. on Same Lot .... ..
10. 'A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STRUCTURES AND USE OF EACH.
H. For (a) Footing: Width _-__-/-Y Depth in Ground L.t- Width of Wall ._6'
Accessory
Bldgs. and (b) Size of Studs: ? V 'f Spacing / (0, "CC Material of Floor ____.._......... ...........
Similar
Structures:
(c) Size of Floor Joists:2‘_}L4 Spacing .. ...._I_4 "CC
` (d) Size of Rafters: A-.l(__. Spacing 14 "CC
12. VALUATION OF PROPOSED WORK: Including+ n_a �0all labor, plumbing, electrical wiring, heating, fire sprinklers, paint-
ing and sewage disposal $ • 7�---U
13. I HEREBY CERTIFY THAT TO THE BEST OF 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 CALIFORNIA APPLICABLE THERETO.
•
1$2
• Plans Filed:
Signed:---.12 1 -.� -f- �.
yy,---o (Owner)
By:- L / 4F11....-4Q<.
(Authorized Qgent)
FOR DEPARTMENTAL USE ONLY
FEES: - CHECKING BY
Bldg. Permit - $. I 51,("b GROUP„LnvII APPLICATIOON � ' HEALTH
Plan Check q ' Jj-8
3 TYPE _____________ __ + FIRE
Total - - - $ J.' ZONING
v o DIST. r MARSHAL
Receipt No. - ,....C.2-�� MAP �`� SPEC'S �'_�
SHEET NO 'c STATE
Paid to CORREC- IONS /� ENGINEER
Date _/ V/Wes77 VERIFIEHCAL
/ y✓ PERMIT I $ZJF3N B030N Lz . _T COUNTY
TOR BUILDING
DATE L-__ �`1 vv
sn-i-so 7 - .. -_ ;3 /• DEPUTY �.
�Fy I/
METES AND BOUNDS DESCRIP. ,N: •
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UWNtR MC CULLOUGH, ROBERT A. UAIt 4-22-75 •
JOB ADDRESS 2156 Rural Lane BUILDING PERMIT NO. 398.94
GENERAL CONTRACTOR Owner Bldr. DESCRIPTION of WORK Remove Partition
APNo.118-032-28 LOT TRACT FIRE ZONE VALUE $ 100.00
' INSPECTIONSSignature Date TYPE `7 GROUP j ZONE R2
SOIL PERMITS ISSUED
GAS SUBCONTRACTOR
Date Number Signature
WATER Plumbing •
ROUGH PLUMBING
PROP. SWR. LINE ❑ HOUSE CON. n
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND ❑ POWER n
ROUGH WIRING Heating and Vent.
TRENCHES fl FORMS STEEL REINF. fl
FLOOR SYSTEM
BOND BEAM n STEEL REINFORCE n
SHEATHING
FRAME AND FLASHING
LATHING - IN n OUT n
PLASTER, BROWN COAT
STRUCTURAL, FINAL Elcctr't
HEATING, VENT., REFRIG, AND A.C., FINAL
PLUMBING, FINAL AND GAS TEST 7
ELECTRIC, FINAL
iv PA..
f •
• •
• 39894 wn 22-75c,,.•00 81R:, ***:x5.50
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely RECEIVED BY DATE RECEIVED DATE ISSUED
BUILDING ' s (tea Q,
ADDRESS Z''��p 1=+..�P{�LLA.,j C.til, `C [�/,
1 , A, McCukbvn� IIb-o'28 PERMIT NO.
OWNER T' A.P.NO.
MAIL BUILDING *Inco eg yRAl '
Z
ADDRESS C — /0L 1111.44 h Leri S�'r ADDRESS /��b Vl'•s-'�-
Q. U CITY Nhhi /GN $ .oil- l NOL 6.314/110 TRACTH(02_ LOT l BLOCK
CONSTRUCTION _ NEW ADD ALTER REPAIR MOV NG OFM01 ISH
OCO LENDER Na-IC /
J D BRANCH - r/-��� .�j ,A�/I, ) mss, I
_J CO OWNER T( IP , Cr:
v\JC^tT
< UJ ADDRESS ,/�1ttttcc" /� �-T- �/ i
J• m ARCHITECT TEL. USE - 1 Emo I I✓ 1- WAU VALUE$ '�� �_
Q OR ENGINEER NO. I
o°3 FIRE 2 ADDRESS ZONE YPE GROUP ,...----
Z /
/�• lAirl APPROVEDri
4.Q.2-"q<
.QIn _��[
J O CONTRACTOR L,•wI/,JC�. BY DATE [•(r 7
03
J¢ ADDRESS 45 444-
tO W u TEL. Z NO.OF USE OF NE }��j
Cr CITY NO. 1�� jP�'� BUILDING �� `l�i1 rLV�
10 STATE CITY YARDS APPROVED YARDS APPROVED
fn m LIC. NO. LIC.NO. .MAIN BUILDING ACCESSORY BUILDING
D O (FROM C/L STREET)
512E 1 NO.OF BLOTS. FRONT FT. % C5z FT.
OF LOT NOW ON LOT
USE OF
EXISTING BLDG. R SIDEl'� t-f FT.
I- SIZE OF NO.OF h
Z NEW BLDG. ROOMS STORIES L.SIDE _ FT.
UEXTERIOR WALL ROOF ,
COVERING COVERING REAR FT. FT.
J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
d MAIN BCS. _ACCESS.SLOGS.
C. LO
QVAR.# DATE
REMOVE- PA,arlfl A/ C.U.P.# ,^^ APPROVED
0
I— APPROVEDL) u )12Y/ 22-75'-
CO 2 BY 1 ST1 E
0 /STATE\
0 I herepy acknowledge that I have read this application an state (tit
D that the above information is correct and agree to comply with rl
CC all laws regulating building construction, and I shall not employ
F any person in violation of the workman's compensation laws of
to the State of California. m
Z I hereby certify that I am properly licensed as a contractor under S0. FT. p
the State of California Business end Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR •
Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
tc
am exempt from the provisions of the State of California Business VALUATION ,...�sy//
and Professions Code,Division 3,Chapter 9. L t V! ry
PERMIT FEE $
Signator of s'✓//�� ` � fr ) � m
Permittee "�'s���1'fid $ /0- PLAN CHECK $ 94/......„......-- E
Authorized Agent ` o
TOTAL FEE $
LL
OWNER LIBBEY, C. & L. DATE 2-8-61
JOB ADDRESS 2151 Rural Place BUILDING PERMIT NO. 13813
GENERAL CONTRACTOR Owher-Bldr. - VALUE $ L00.00
AP.No. 118-032-13 LOT TRACT _ FIRE ZONE DESCRIPTION OF WORK Eric.Porch for-Der
INSPECTIONS DATE I GROUP I TYPE V ZONE Rl
Underground Soil U.G. Water SUBCONTRACTOR PERMITS ISSUED
Underground Gas DATE NUMBER
Overhead Water and Gas
Rough Heating
Rough Plumbing '
Miscellaneous
Prop. Swr. Line House Con. St. Swr.
Sprinkling System
Heating, Final •
Plumbing Fixtures
Final Gas Test
Construction Pole
Underground Power-
Rough Wiring
Trenches ✓Forms Steel
Floor System
Steel Reinforce Chimney Re-Rod
Bond Beam
Sheathing
Frame and Flashing
Lathing, In Out
Plaster, brown coat _
Plumbing Fixtures, Final
Electric Fixtures, Final —/
Building, Final r/IL�],, 6
�
OCCUPANCY �
Form 210-5M-11-59 S-B P .. - 13813
•
13813 FEE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT g-- Iq 6I
P. O. BOX 917 COSTA MESA. CALIFORNIA __J5---•
DEPT.
For Applicant to Fill In Completely FINANCE Vita PP P Y APPIaliEATAOnak ��ERMIT
TYPE OR PRINT) BUILDING
BUILDING 11)-(a t_u to L._ ?LP.c I_
_
ADDRESSCOSTA MESA. CALIFORNIA For Office Use Only
•
(�1 a lf 11'' ,,/ RECEIPT NO. PERMIT NO.
OWNER (L/`!I�IC/I=` L1 it. L. ( fl /
RECEIuBY DATE RECEIVED
MAIL DATE SSU
4
ADDRESS A-t0v it-L.. -flat Ip—t-4/ -d -'0/
I/ MNG/
CITY NO.5-- t 3 ADDRESS t I5-.4 veva y^ ^eL-
ARCHITECT TEL. COSTA MESA. CALIFORNIA
OR ENGINEER NO.
ADDRESS FIRE
Ca
// ZONE TYPE GROUP
CONTRACTOR jJ'(/I.L71.i it i �(I- cc<_( G/2- APPROVED (-5.d.„14._BY //V((// DATt � 62..._‘..1
ADDRESS NI NG
ZONE „/.1I NO.OF USE OP NEW/ /f ¢- 1
CITY r(\.• PLANS I BUILDING p 0eseh •
STATE TEL. LEGAL , (�/� i.
LIC.NO. NO. _ DESCRIPTION ,,,..--'21-1,,,..--'21-1.-• i/,7- p\ • I V V f-.
SIZE !.��� NO. OP BIDOS.
OF LOT J LJ x Now ory Loi p p NO 1 ' S-_. (f .32 --/ 3
USE FI F'0 (•t.-cL4- (1 A� - YARDS I--/ EVES
EXISTING BLDG. �L. P 1= APPROVED ALLOWED
SETBACK PI ST FR
PRTM (CENTERLINE ET I /
CENTER OP STREET REAR YARD FRONTTCat(*)
� 1 �•--1-11, IN.
SIDE YARD I LEFT I RIGHT R.SIDE 9 FT. _Elf,. IN.
DESCRIPTION OF WORK Tr FT. y�OI IN.
(/J� L.SIDE r��
NEW I II ALTERATION I " II ADDITION REAR OV—
/SFT.{ � . IN.
REPAIR I MOVING I DEMOLISH APPROVED /.q/ y Y/ DATE a ' ('p/
BUILDING NO. OF 4Y/ D• f
SIZE ROOMS �[)�J STORIESpI� /_ /
EXTERIOR WALLS''U CC()COVERING 11- `^P�0314.
COVERING J
USE OF BUILDING AND WORK TO E PERFORMED y
.P4I.L(tP.@-ti a /f,I ea rl,4 , r. A ins,
7
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT A I AGREE TO COM-
PLY WITH ALL CITY ORD NANCES ET LAWS REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
BUILDING CONSTRU VALUATION
SIGNATURE OF r p..4/ PERMIT FEE $4•
PERMITTEE J l
' / $ PLAN CHECK $ r-
AUTHORIZED AGENT rt.- re
® /il TOTAL FEE $-2 u.
0