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Home My WebLink About1918 SANTA ANA AVE - Building Permits CITY OF COSTA MESA y i BUILDING DIVISION ti ""^� ' DEVELOPMENT SERVICES DEPARTMENT P98-00455 4. a- PERMIT PERMIT NUMBER (714)754-5273 • Fax(714)754-4856 PLUMBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1918 SANTA ANA AV Status: ISSUED et6 Suite No Applied: 06/08/1998 • Issued: 06/08/1998 Vicinity: Parcel Nunmber: 42629102 • Applicant: ZARATE, SIXIO Address: Phone: ,. ' Zip: Owner HAFER, WENDY C Address 2407 BUNYA ST . , Phone: ' NEWPORT BEACH,CA Zip: 92660 Contractor: EVAN'S PLUMBING Address: 1720 WHITTIER Phone:-646-1185 COSTA MESA,CA - 1 Zip: . - 92627 • , - License:, , Arch/Eng: - Address: Phone: • - • Zip: License: ' • SCOPE OF PERMIT REPLACE WATER LINES AND REPIPE WATER SERVICE. FEE SUMMARY AMT QTY AMT _QTY AMT QTY ISSUE FEE $22.00 Laundry Tub/Washer -$0.00 0 • Sump Pump - $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap - $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal. $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00' 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0' Wash Basin $0.00 0 Dishwasher $0.00 0 • Sewer Cap for Demo $0.00 0 - Wash Basin Set $0.00 0 Drain,Floor $0.00 0 - , Sewer Connect • .$0.00 0 Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 ' Sewer Private Line $0.00', 0 Water Closet(Toilet) $0.00 0 Drain,Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 r Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 ' Sink,commercial $0.00 0 Water Re-pipe $8.75 1 Gas Earthquake Valve $0.00 0 , Sink,Floor $0.00 0 Water Service $8.75 1 Gas(1-4 outlets) $0.00 0 Sink, kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 . Spa(private) .$0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $39.50 COMMENTS/SPECIAL CONDITIONS EXP lot,x7 a' DM ‘51A /7767- 7-79)4 ell EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. O I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carer and policy number are: Cartier: Policy Number. (This section need not be completed it the permit is valued at one hundred dollars($100)or less.) ❑ I certify 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 workers' compensation laws of Cali . ia,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these proe. A p1 ApplicenLSigneture: .iy Date:: (Y— 9` 9A WARNING:FAILURE TO SECURE ORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(s1 W,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full force and effect.Lin.# Class# Contractors.Signature: �2 Date:_6- f'-9� CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom 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 penalty of not more than five hundred dollars($500).): ❑ 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 or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet In depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a,permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? j�Yes Ld No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for jpspection,pu�rpnos_es.,l agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signatur Legal Ow,garts) C �_ Date And/ A'�(u lorizeddAppOIoant =Date= =Lit. INSPECTION TYPE PATE 211IDAL5 CODES INSPECT ON TYPE DEE ItIMIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical _ 1266 Pool Spa Final 206 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 2446-46 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY CIF COSTA MESA CONSTRUCTIO PERMIT PERM.111- NO. TR CT O. LOT NO. UNIT NO. 1287 J/19/06 I'I.0cL TL f: ,� chr�/a9 '--�5 por La -Project Address /I//Sf SA.tJ tit ,tit/� tie - •Mailln Address' $Bj'✓1C' ' TYPE OF CONSTRUCTION • ❑ NEW ❑ ADD ❑ ALTERATION ❑ REPAIR ,�/ �g� e0,16-/2-go? ❑ CONVERSION ❑ DEMOLISH ❑ OTHFJ�� / �,. ' ,, / /' A•R # g-1/ __ X19/— 0,9-, Zone' Owner's Name c,(-J�y-/l OF h SA-/ PhoneDESCRIPTION OF WO K/US?OF B k-�r-C�C�V 1/lL �--^ C7+C17 oG 7 �X.� �� ,y Address S•h1E' 95 • WN�4 S Main Building: Accessory Building: hlr 7t.R.lA/!.t-�•'�Z E /^ 4J Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION STRUCTURAL T Front AA I G Address ❑'TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL BA Rear OI N • ❑ -OTHER n f N " Contractor's Name Phone - - -- - C Right 2PROJECT DESCRIPTION SQ. FT. OCCUPANCY G Address(mailing) Q K 1 g CONSTRUCTION TYPE VALVATION$ I�D S L ' 1O R City License No. ZONE GRADING CU.YDS- ACRES Ping. Ref.# Parking Req./Provided E LICENSED CONTRACTOR DECLARATION - Ihereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Ct,TY S 1�' Planning Notes: I�r /�st�r �j I /'•� 01 Q with section 7000) of Division 3 of the Business and Professions Code, and 1_ 'u /0 I ' l�//1` / q5 i 'tF- b ha A, U M my license is in full force and effect. V l//1 License Class - License No. • S Date Signature PLUMBING FEES A WORKERS'COMPENSATION DECLARATION . Bar Sink Showers ereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES Workers' Compensation 'Insurance, or a certified copy thereof (Section 4800, Lab. C.) Backflow Preventer Service Sink ' - f• - Automatic Washer ' Transformer ❑ 15-50 KW Policy No. L- Company - Backflow Irrigation Sewer Cap Construction Pole Sub. ❑ 50+KW 8 Certified copy is hereby furnished. — - Certified copy is filed with the city Building Division. I Bathtubs Sewer Connection Cooking Unit Meter 'Our)to 100 amps Date Applicant - - - EXEMPTION FROM-WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher • Meter Dover 100 amps (This section need notbe completed if the permit is for one hundred ($100 or . less). Dishwasher Solar Piping Dryers ❑Gas DElectric Sub Panel 1 I certify that in the performance of'the work f h this per r is issuI �— shall not employ any person in any man o become sub' the ,., Drinking Fountains Solar Tank - - Fan Motors❑0-1 HP ❑I%-B Work r ;Con�enp_t_r yin Laws of Cali or - Date as [� Signature �"'« Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar ❑9-15 HP ❑16-15+ 'NOT CE: If,after making this decla tion,you should become-subject to - - - Workers' Compensation provisions of the Labor Code, you must fort Floor Sinks Urinal Fixtures Microwave comply with such provisions or this permit shall be deemed rev ed. CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet I hereby affirm that there is a construction lending agency for the performance Device Boxes Pole Light i of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater O •utlets Name Range • Lender's Address - - - Kitchen Sink - • Water Service - - Switches - OWNER BUILDER DECLARATION . Sign - I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Disposal !Standing Sections Garbage • 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 Laundry Trays 'Generator 00-5 KW 05-15 KW , 'T•rash Compactor any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of • • • Roof Drains' - ' the Contractor's License Law(Chapter 9 (commencing with Section 7000) of - - - flivision 3 of the Business and Professions Code) or that he/she is exempt - erefrom and the basis for the alleged exemption. Any violation of Section ' )31.5 by any applicant for a permit subjects the applicant to a civil — i penalty of not more than five hundred dollars($500). I $ 3 ❑ I, as-owner of the property or my employees with wages as their sole Reinspection Fee $15 . . Issue Fee - • compensation, will do the work, and the structure is not intended or offered - Reinspection Fee I $15 Issue Fee ' $ 3 . for sale (Section 7044, Business and Professional Code: The Contractor's - MECHANICAL I 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 Boiler Hood or Type ❑ DEVELOPMENT SERVICES REQUIRE-. TS,; �� employees, provided that such improvements are not intended or offered for �/ sale. If, however, the building or improvement is sold within one year of coin- - Canopy Type II. ❑ Zoning Approved By ` Date . Ea: .. pletion, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground ' - Building Approved By — ��>•� :ate3 1i41. r prove for the purpose of sale). - ^ ////r7� +� ❑ I, az owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Appliwttn Issued By ].• Dat —./i/iii/ ' 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 ❑0-100,00 BTU ❑100,000 BTU SUM Aggq��V pppF FEES builds or improves thereon, and who contracts for such projects with a that - _ 2 1 /'yam .�� tractor(s) license pursuant'to the Contractor's License Law). I am aware that Exhaust System D Multiple ❑ System Repair/Alterations X• P I t BUILDING PERMIT $ • 14J` SMTP $ • proof of their Worker's Compensation insurance should be provided to me. _ r14-11 ❑ I am exempt under Section B. & P.C.for this reason Firepl/Fact.Bit. ICBG# Fire Dampers Incomplete htS( • tuft% PLAN CHECK $ /1-5- ISSUANCE $ PLUMBING $ Date ' Owner Heating System&Ducting Registers L. PLAN CHECK 25% $ ENERGY P.C. $ I -hereby certify that r have read this applicatio .•- state that the above 0o-100,000 BTU ❑100,000 BC time „IG _ ELECTRICAL $ GRADING $ information is correct. I agree to comply wit• , city a d county ordinances and state laws relatin• uilding constr ion, and --reby authorize repre- P N CHECK 50% $ MICROFILM $ [t sentatives of y • enter upo�ya�lo . entioned property for . - inspection pu,y - M CHANICAL $ TOTAL FEE $ SI 44,5 Signatur- 'i � - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor CONSTRUCTION AND-PLANNING POOL&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 Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement..) /_L� tilos �SS� r 56. Rough Plumbing & Pressure Test zuoppl 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings NS;Si os 58. Electrical Conduit-Undrgrnd. 8. FoOndation• 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 Electrics)-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 0 Gas IP 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 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: f, S factoxQ� _ / 34. Final Heating & Air Conditioning c �d 35. Final Gas Pipe-Test 36. Hood or Canopy 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 Attenuation - EXP 1 R E D :46. Handicap Regulations Inco lete incoections 47. FINAL STRUCTURE & BUILDING pate - 1� 48. Special Requirements Completed '- 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co `Y 51. CERTIFICATE OF OCCUPANCY No. - Date • OWNER DINEHART MRS. META AUG 1 0 1961 DATE 8-5-60 • JOB ADDRESS 19161 Santa Ana Ave. BUILDING PERMIT NO.126141 GENERAL CONTRACTOR Owner-Bldr. VALUE $ 250.00 AP. No. 1181T-17 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Slab for Porch INSPECTIONS DATE I GROUP I TYPI3T ZONE Rl Underground Soil U.G. Wates _ _ _ 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 1/ Forms Steelf',-' ( •-q-(o Floor System Steel Reinforce Chimney Re-Rod Bond Beam P Sheathing Frame and Flashing • No Lathing, In Out ,r) Plaster, brown coat Plumbing Fixtures, Final Electric Fixtures, Final _ Building, Final OCCUPANCY � - /. /7_6/ Form 210-5M-11.59 s•a P 126W1 12644 AUG 5 1960 COSTA MESA BUILDING-SAFETY DEPARTMENT a:4-- ,, P. O. BOX 917 COSTA MESA. CALIFORNIA +I 1, Cl ,. v''1 For Applicant to Fill In Completely APPLICATION FOR PERMIT Q TYPE OR PRINT /J ADDREIN /9/O Sites 4a //tif BUILDING COSTA� MESA. CALIFORNIA For Office Use Only NIM/IOWES/' 74 .QUVFNAR / I RECEIPT NO. I PERMIT NO. MAIL REC81V D BY DATE RECEIVE ATH ISSUED ADDRESS /%Q/�IL�9�N7pA�9/�A/"f VE 8-3e � s'S-4.c I Y-.�-1 0 CITV��S�j7/(/�.?/7 NO IV DDRESS ARCHITECT TEL. COSTA MESA. CALIFORNIA OR ENGINEER A/ NO. ADDRESS FIRE U , (1 ,,// II// ZONE \ )�91j', TYPE GROUP "al- CONTRACTOR Z�nr BYPR 1. ) y1 DATE ADDRESS id:U ZONING ZONE I f NO.OF I USE OF NEW CITY PLANE BUILDINGSit [., STATE TEL. LEGAL �T'7� R/ LIC.NO. NO. DESCRIPTION/Piet /RA' SIZEV NO. OF BLOTS, f��.`R 1 , t�19,` j OF LOT Q p �gQ NOW ON LOT . A.P.NO. ! ' ` USE OFfl� YARDS EVES EXISTING BLDG Ab. - A r"v-617 R -C - APPROVED ALLOWED � SETBACK CENTER OP NBTREETM ��f �-L REAR YAARLDy 3 FRONTR LINE Blatt 6 'Y--y,I IN. SIDE YARD I LEFT L I RIGHT O O R.SIDE //�j/'/V''/R sc. / ! /� IN. DESCRIPTIONyIOF WORK L.SIDE (1j e 6.1 IN. NEW I " II ALTERATION I II ADDITION I ✓ REAR .re FT. 4-' IN. IIREPAIR I II MOVING I DEMOLISH I APPROVE //` / C / DATE b_�_ / Q BUILDING NO. OF �(/ o �C�J SIZE ROOMS STORIES EXTERIOR WALL i ROOF COVERING COVERING .T USE OF BUILDING AND WO K TO BE PERFORMED 7-1 5 is 1 -0 z C . 1X2 A i✓ 1 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRU ON. 1 VALUATION +� SIGNATURE OF i„.....- mite _)UnQ A , p.G PERMIT FEE $ />-�- PERMITTEP c 5-O X o_ S PLAN CHECK S AUTHORIZED AGENT al _ TOTAL FEE S 0