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Home My WebLink About3424 SUMMERSET CIR - Building PermitsL , :;,:�,* � y . �� •.m..�:: 1 �': (714)754-5273 • Fax(714)754-4856 Job Address: Suite: Vicinity: CITY OF COSTA MESA BUILpIN6 DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT BUILDING PERMIT 3424 SUMMERSET CI RESIDENCE & ATTACHED GARAGE. Parcel Nunmber: 41207339 npp�icant: SELL, RON Address: 1653 SUPERIOR AV Owner. Address (' Zoning: R1 R1 , , , r ' � Phone: 949-642-7222 COSTA MESA CA ' Zip: 92627 , POTTER;.ROBERTJOSEPH 3424�SUMMERSET i i � � � � — ,ty,. � �- �/STA MESA, CA � �j / � : - . � .� ��%iZ..:.. . \SELL ROOFING COMPANY 17072�ROSEBUD . NUMBF.R + 77 FAIR DRIVE, COSTA MESA, CA 92626 ISSUED BY: Status: ISSUED Applied: 06/07/1999 Issued: O6/07/1999 � �' \ Phone: � ' `+._ ,� '�✓ �:� � Zip: 92626 t - =' .' ,.�� ,' % � < � % VA� \ ��`\:. ��i� �� A i. �� f�(i� / /!.%/ Phone: 714-9933328 �,.'\� j � �C1 � � �� ' YORBA��LINDA CA � ' �-� � : , � j '1-,� ��Zip:��- 92686�' License: 323842 - � , �'��' � � `�`, " �'' � � � � �� i- i . rN - _ . . - � , - . ' Arch : ' � . , Eng: � �, . , ' ,?� `, � �Address:_ � % j� � � '" -� ' �� ' Address:. , r,.. " 1 �� r! � ` — , � ' � "-Phone: - - . Phone: . - ��,��, ! �, = , ,j. ; r : ' � - +'� , A - . '� �{L? `. , t ,�� Zip � � :. - . . License: Zip: - - License: _ , � � !� �� ; � � '` SCOPE OF PERMIT � - � �� ' ' �� ;�. f REROOF: T/O SHAKE; INSTALL t/2" OSB; 2 LAYERS OF 30#; REROOF WITH "EAGLELITE CAPISTRANO" TILES "�� ' i� (ICBO#4660).27SQUARES. � � � � � - '- ' ' - ' ,,� � r: .. , . � '-. i i �� ' ' � FEE SUMMARY .� � �� Plan Check: � � '' $0.00 � � � �� ' � � ' � '� . Calc Valuation: � � $a,sss�oo,l ' �' ' - Permit: $149.75 i , Claim Valuation: , � , ' sa,sss.00' �� SMIP Res: -�. $0.90 � %� �� 'SMIP Com: $0.00 - _' _ ��„� ' ` Other.� $0.00 � ; ;�� `,`r ;�1; `:�Inspection`.'� '': $0,00 �� A -.._ , '+' � Total: , $150.65 � �``��/� .�� / \�1\ ' .. '.'.:�_ _, :;4, . .. _ . - . _ �. �. ii �ti,;� ;;. �• �� .� � SETBACKS .� � MAIN STRUCTURE �FFont 0= 0 �' : . � ACCESSORY Front" 0.0 � PARKING Existin : � o � NOTES: , - Rear- �0-0 - Rear 0- 0 NG & ZONING ,� < - Left � 0- 0 Right _ Left 0. 0 � Right Reouired: 0 Pr000sed: 0 ,. EXPIRED nAxe a� o i NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 9248, § 7, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned I for a period of 180 days. � INSPECTIONS: In order for the work euthorized under this permit to be considered legel, such work must comply with all applicable codes, and all ��. requlred Inapeetlone and final epproval must be obteined. Feilure to obtain inspections and tinal approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 WORKERS'COMPENSArON DECLARAnON: . . . , � I hereby eXirm untler penalty ai perjury one of the tollowing tleUarations: ., .. . -� ... , ' � I heve antl wlll maintain a ceRiticate of consent to self-Insure for workers'. compensation, es provitled for by section 3700 af the Lebor Code, tor the peAortnence ot the work for which this pertnit is issuatl. , ,. ❑ I �ave and will maintflin workers' compensatlon insuran as requiretl Dy seclion 3700 of the Labor Code, for the pertortnanca of the work for which this permit Is issuea. My workers' compe nce car and polic umber ere: l 6(� 6 S� Y Carner: � Policy Number: (This section need n f comp/eted i! the permit is valued et one hundred dollers ($100) ar /ess.) � ❑ I certify t�at in the peAormance of the work tor which this permit is issued, I shell not employ any person in any menner so es to become subject to the workers' compensation laws of Celifornia, and agree Ihat if I shoultl ewme �ect to the workers' compensation provislons of Section 3700 of the Labor Code, I shall forthwith comply with thase provisions. /�//J_ /� Applicant Signature: G/l ��!/L Date: 7�� 0 WPANING: FAILURE TO SECURE WORKERS' COMPENSATION COVEPAGE IS UNLAWFUL AND SHPLL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES ANO CIVIL FlNES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000�, IN ADOITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIOEO FOR IN SECiION 31W OF THE LABOR ODOE, INTEREST, AND Al70FNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby attirm Ihat I am licensed force end ettect. Lic. # Contractor's Signature: _ (commencing with Section 7000) of Division 3 ot Ihe Business and Professio Cotle, antl my license Is in full � class a C — 77 � Date: !a ' �i / ' CONSTRUC710N LENDING AGENCY: ❑ I �ereby aHirm thet ihere Is a conswction lending agency for iha pertormance oi ihe work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lender's Adtlress: SignaNre: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that undar penalry of perjury ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7037.5, Business antl Professions Code: Any ciry or counry which requires a permit to consiruct, alter, impmve, demolish, or repair any siruciure, pnor to its Issuance, also requires the appliwni tor such permit to file e signed atatemeni that ha or she Is Ilcer.sed pursuant ro the provisions ot Ihe Conirectors License Law (Chapter 9(commencing with Section 7000) of Division 3 of �ha Business and Professions Code) or Ihet he or she Is axempt iherefrom end Ihe basis for Ihe ellegeC exempNon. Any violation of Section 7031.5 by any applicent tor a permit subJects the applicant to e clvil penelry oi not more than five huntlreC tlollere (5500).): ❑ I, as ov+ner oi ihe properry, or my employees wiih wages as their sole compensation, WILL DO THE WORK, antl the structure is not intentletl or oHeretl For sale (Sec. 7044, Business entl Protessions Cotle: The Conirectors License Lew does not epply ta en owner of property who builds or Improves Ihereon, end who does such wark himself or hersetl or through his or her own employees, pmvided that such improvements are not intended or ofteretl for sale. tl, howeveq the bulltling or improvement is sold within one year of completlon, the owneo-builder will have Ihe burden oi proving that he or she did not build or impmve tor purpose of sale.). ❑ I, as owner of ihe properry. em EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct Ihe pro�ecl (Sec. 7044, Business and Pratessians Cotle: The contrectors License Lew does not apply ta en owner of properry who builds or improves Ihereon, entl who contrects for such pmject with e coMracbr(s) license pursuent to Ihe Conirectors License Lews.). ❑ I em exempt untler sec. Business and Protessions Code for ihis reason: SignaWre: Dare: Owner ID verified by dnver's license. ❑ Ves ❑ No Drivels License No. Ezpires: Verliica�ion ot Ownership by (rype of daumenL i.e. - property ta�c bill or tleed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certity thef no excavetion five (5) or more feet in depth into which a person Is requiretl to descend, will be matle in connection with work authonzed by this pertni6 and that no builtling sWdure, scattolding, felsework, or tlemolition or tlismantling thereot, wiil be more than ihirty-sia (36) teet high. (Chep. 32, Grp 2, Art 2, Sec. 341, Tltle 8, Califomia Administrative Cotle). ❑ As owner-builder, I will not em0loy enyone to tlo work which would require a pertnit from Ihe Division of Indusirial Safery, as noted ebove, unless such person has e permi� to tlo such work from the division. Signature: Date: Division of Intlustnal Safery Pertnit Number: GODE t. INSPECTION TYVE 1616 FIxeO System Finel Fire Prevention 1268 200 201 202 203 204 zaae-ae Pool Spa Final Final Re-Root Final BIxWRetalning Well Finel Fectory Fire Plece Final Sign Finel Demolitlon �i: � QQpge INSPECTIONTYPE 206 �� Final Mechenical 208 Final Plumbing 210 � Final Electrical 212 Final Fire Preventlon 220 Finel Planning Approval 222 Final Sita 250 Final Builtling/OccuDancy �� $ (-,�.' F o.�:•`3` . ;�'1 ° `�r:,.,�. . Applicant to fill in all ci.rvoF.cosTAMESA CONSTRUCTIONPERMIT 1: • -' . "PiojectAddress .3�a� Cl�t'C�r'M1�'Jf._.� �:_. /� ;y;-�' ApplicanYs.MailingAddress• ��v��nG-`v`h C-�-17-� Owner's Name `�O�s.� pt�ci�.QS�. � Phone ' � `� Address 3+'�'ay S��rc�.cc�no-�� ; � - Arch/E g. � ' License No.� M Address � � � 'u� " �'' . C T' . ��rC. Phone�g- S113. Contrac� r's Name � Addresslmailing) �� n��Ch � . City License No. 3 �- �� O LICENSED CONTRACTOR DECLARATION I�hereby ai(irm that I am'licensetl ntler provisions 9(commencing with section 7000) oi Divisio o the Busines ntl Profes s Cotle, antl ' my licenie is In full force ana itect. License qass � cense N ��, � Date �O—LO Signat WORKERS' COMPENSATION DEC �RATION � ' xreby aifirm that I have a certiticate of mnsent to selt-insure or a certificate Workers'.Compensztion Insurance, or a certitietllcopy.thereot.(Section_, ' .JO, Lab. CJ /' ' Policy No.;u%�p �01�i�13 CompanylTKO-� QMO..\�CG'n e Certifietl caOY is M1ereby furnishetl. � � � < Certifi is filetl with the city Builtlin Di i�. I \ Da[e • ��' � APPlicant ' � L✓�C � � �4 EXEMPTION,F0.0M WORKERS' COMPENSATION DECLARATION � Y.. (Thiz sectiOn neetl not be c�npletetl if the permlt is for one huntlretl ($100) or ,,y less). -- � • I certify.thaLin the perto�mance of the work fOr which this p¢rm�t iSissuetl, I� 5M1a11, not employ Sny pe�son in dny manner so as to become subject to'the ' Workers' Compensation' Laws of Califomia. f Date ' ' ' ' Siqnature NOTICE: If, itter makin9 this tleclaration, you s�oultl become subject to the . - Workers' Compen5ation 0/ovisions o( the� Labo� Cotle, you musbfbrthwith comply witn such O�ovision5 or tnis permit shall be tleemetl revoketl. , CON5T0.UCTION;LENDING�AGENCV - - ' - 1 bereby atfirm tM1ai there is a conztruction IenGing a9ency for the perfarmance ot the work for which• fhi5 permit is iszuetl- (Sec[ion 3097 Civ. �CJ LenOer'S Name - Lentler's Atltliess - � � OWNER BUILDER DECLARATION-�� - - ` � " I hereby atfirm that I am exemp[ from the Contrictor'S License�Law tor tM1e ' Pollowin9 reason (Section ]031'.5 Business antl Professional Cotle: Any dty or county which r¢quires a permlt to consbuct, alter, improve, tlemOlisM1 on�epair 'any sVucture, prior to its issuance, also requires the applicant for such permit 'to tile a SignEtl sta[ement that he/she is licensetl pursuant to the p�ovision5 ot � '^e Contrac[or's License Law (Chapter 9(commencinq with Section �000) of . `sion 3 of tne Business antl Professions Cotle) or that he/she is exempt , •from'antl tM1e basis for Ihe alleqetl exemption. Any violation of Section LS iby any applicant for a pe�mit subjects the'applicant to a civil .ialty of not more Ihan five huntlretl tlollars ($500). .� '' '� I, as owner of the prope�ty�or my employees with wa9¢5 as thei� Sole - rompensation, will tlo the work, antl the stru<ture is not intentletl or otierea for sale (Seciion ]044, Bvsiness antl Professional Cotle: The Contractor'S � License Law'tloe5 not apply fo an owner of a property who builtls o� imp�oves thereon, antl who tloes such work himself/hers¢If or through his or, her own employees, provitletl tha[ such-improvements are not intentletl o� offeretl for sale. If, however, the building or improvement is soltl wllhin one year of com- pletlon,�the owner will have the burtlen Of proving h¢/she tlitl not builtl or irn- ��ove forthe purpose of sale). I,;as owner of the prooerty, am exclusively contracting with licensetl con- tractors to wnstruct the project (Section 7044, Business antl Professions Cotle: The Contractor's License Law tloes not apply to an owner ot;pronerty who builtls or improves tnereon, antl who conGac(5 for such projects with a com / tractor(s1 license pursuant�fo tlte�Contractor'S LicenSe Law). I am aware,tha[ proot o( [heir Worker'S Compen5ation insu�ance shoultl be provitletl fo me. ❑ I am exemp[ untler Section g, g, p, C. for this reason ' Date Owner, ' � � I hereby certify that I have reatl this application antl-state that'the atiove informa[ion is correct. I agree to comply with all city antl county ortlinances antl state laws reiatin9 to builtling constructlon, antl hereby authorize repre- sentativqs�al this cilY to ppter ppon tne above-mentionetl orooertv for • exceot tnose within heavy bortler lines antl sign all approDriate aeelaralions: TRAC7 NO. , LOT NO. � UNIT NO. Z ,• . . - TVPE'OFCONSTRUCTION� LJ NEW�AD� L.J ALTERATION LJ REPAIR � ❑CONVERSION.❑ DEMOLISH O HER � � q:p.# ' -DESCRIPTION OF WORK/USE OF BLDG. - - � '- . . ' - - � � • � ' ' S Main Builtli TVPE OF PERMIT `❑-GRADING- ❑ FOUNDATION STRUCTURAL � ' T Front O TENANT�LECTRICAC ❑ PLUMBING ❑ MECHANICAL � B Reaf � 1 O �OTHER � \ � � �� A � C Right . PROJECT DESCRIPTION 5q. F7.' - ocCUaArvcv K. CONSTRUCTION TYPE ' VALUATION S' S Left ZONE - _ � GRADING CU. VDS. . ACRES Ping. Ref. #' Rema:ks: . � ' i ' � - Planning Notes: Sink � <flow Preventer <flow Irrigation Drinking Fountains . I Floor Drains � � ' � FloorSinks� �� - �- Gas Service , Outlets � Interceptors • Kitchen $ink - . � ' Lavatories ' ' ` ' P-Trap . Roof Drains ` - - � . , ReinspeMion _Fee� $15 Under Ground Structural Exhaust System ❑ Multiple Firepl/Fact. Blt. ICBO �1`- � Heating System & Ducting ❑aiao,000 eru��ioo;aoo PLUMBING' ' Showers - �-SeiviceSink � ` Sewef Cap Sewer Connection � Solar Collectors � ' Solar Piping Solar Tank Swimming Pool w/Spa � - - UrinaP � � — � - i � � . � WatecCloset - � � ) Water Heater :WaterService � _ ". -i ' � FEES — �- � - � Automatic Washer' -- " Construction Pole Sub. . Cooking Unit ' Dishwasher • Dryers �Gas ❑Electric � Fan � r.'� F.A.U. . � - �nxmres -- - - ' - Device Boxes . OULIeLS Switches � Garbage Disposal Generator DO-5 KW 1 ' .♦ - Issue Fee `. , �$ �3 � FEE Hood or Type I ❑ Canopy Type I I ❑ � Refrigeration System ❑0-100,OOOBTU ❑1 1 . System Repair/Alterati Signature �A lK:] � Date \U�b � � ' � Dtivers' Lirrncn nr SS>C � Rainspection Fee $15 Issue Fee CMF 0865-46, rev. 4/64 White - Builtling; Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor . 1 10,000 BTU m - � $ 3 ELECTR 15KW 9827 I 0/ I,0/84 ' I`3,00 ,;TU I Zone Accessory.8uilding: ` �� . � Parki Transformer ❑ 15-50'Kl � ❑ 50+KW Meter ❑up to 100 amps Meter �over700amps Z O ' N I N G R � E Q M T ; S. FEES � Sub,Panel ' Motors DO-1 HP �1 %- 8 Inc.Solar, �9-75 HP �16-15+ ' � 'Microwave-- � - - Pole Light � . � . � Range � i Sign ' Standing Sections Tresh Compactor e I Reinspection Fee � I$15 I � Issue Fee I'$ 3 I DEVELOPMENTSERVICESREQUIREMENTS: � Zoning Approved By Data Building Approvetl 6y Daie�--�� Application Issued By Dat� I()/ N � • SUM ARV OF FEES � BUILDING PERMIT $ SMIP � $ • PLAN CHECK $ PERMIT, , � PLUMBING . $ ISSUANCE , $ � � PLAN CHECK 25% $' ENERGV P.C. $ ELECTRICAL $ .�.00 GRADING $ " ' PLAN CHECK 50% $ - MICROFILM � $ ' MECHANICAL � $ � TOTAL FEE $ , � �O ' PLAN CHECK �25% $ � , ' � � CONSTRUCTION AND PLANNING- ' � . -' P�� 'PA ' � � Y, APPROVALS. Permit #� Date Inspector p�ppROVALS � Permit # ' � Date Inspector �� 1. Temporary Electrical Service or Pole -. 52.� Pool.& Equipment Location �_ � .2. Soil Pipe-Undrgrnd. ' ' . ' 53." Steel Reinforcement• � �� 3. Electrical�Conduit Utility-Undrgrntl. 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�Und�grnd.� � 8. Foundation ' y 59. Gas Pipe, O Undrgrnd., Test , 9. Water Pipe-Undrgrnd. . 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System � , 61�'APPROVALTO 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. Duc�s, in Structure � • i 70. Underground Hydro - . ,. 22. Ducts, Ventilating.� �� , 71. Product Piping O Gas ❑ Oil ' - '23. Gas Pipe-Rough & Test • � : � � �72. Undergiound Flush � � " � 24. Roof Framing • � ' � 73. UndeFgrnd. Storage Tank, ��Gas ❑ Oil ' 25. �Roof Sheathing � - ' � 74, Overhead Hydro � • � ' 26. T-Bar Ceiling (Structurall & Monocoat J5. 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' 37. Plaster Brown Coat � ' � J9. �FINAL INSPECTION �- 32. Electrical Power MeterFinal �. • 0. FOOD CERTIFICATE ISSUED - 33�. Final Electric . `x Notes: � 34. Final Heating & Aic Condi4ioning � � , 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 pomestic-Final � - 42. Backflow Preventer � • • � . . �43.. Backflow,lrrigation-� -, �-.-�-_.�:- �_- , : " � . • ; � . '44. .Landscape Irrigation System• • . �� • '45. Sound Attenuation � � � � � � , � �46. Handicap Regulations � ' . . 47. FINAL STRUCTURE & BUILDING � • • . ' 48. Special Requirements Completed � ' � � � 49. Electric Release.to Edison _ . .. . '. _ . .., •50. Gas Release to Southern California Gas Co � i � �� 51. CERTIFICATE OF OCCUPANCY ' No. � � Date � , ' � . , , ' . F � CW. a = � H � F Q L1 J � � a w a O �i a z � 3 ��<��?3 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Comple[ely - Use Ink Only BUILDING ADDRESS Tract 10277, Lot 45 owNea McLain Development Co. MAIL 1470 Jamboree Road ADDRESS TEL. CITV Newoort Beach ' No. 640-680 BRANCH ADDRESS ARCHITECT ,.. _. _ . llJl Np�'�52.-SSC% 3788 APPLICATION FC�:�� Y D_' iREI A.P. NO. �� Z � �7�— BUILOING ADDRESS '1, TRACT ZOZ%% EW ADD AL ER P ^ OWNER /`7 �L�/A� ♦ ADDRESS 3661 Spruce St., Newport Beach ZONE APPRI CONTRACTOR McLain Development Co. e� ADDRESS 1470 Jamboree Road TEL. ZONE aTv Newport Beach No. 640-6800 Fi STATE CiTv ' YA LIC. NO. Z%3H%S LIC. NO. M SIZE NO.OF BIDGS. (FRO� OF LOT SS X ZOS NOW ON LOT ROM USE OF Separate permits are required for electric, plumbing and heating work. OF BUILDING AND WORK TO BE PERFORMED Single family residence, New House VAR. � 342.3�1 T � T 342.31CKT _ �A..._ ._ SVED NO. LOT 4S I BLOCK TYPE �GROUPJ f' D DATE NO.OF USE OF NEW nD PLAfS BUILDING R�' �APPflOVED VARDSAPPROVED BUIIDING ACCESSORY BUILDIN LSTREET) FT. FT. 5 T. C� FT ,� FT. � FT. (S FT. FT. 3ET. BET. MAIN & F10LD 1 hereby aeknowledpe thet I have reatl this applieatlon antl state that Me above Information Is corract and aprea <o comply with all laws regulating bulltlin0 conrtruction, and I shell not amploy any penon in vlolaSion of Ma workman's compensaSion lewa of the State of Calitornia. 1 he�eCy cartify that I am properly Iicensed as a conttecior untlar rne Stare of California Business and Professions Cotla, Oivlsion 3, THE AMO Chapte� 9, antl thet such licanses a�e in full force antl attact, ot I THE PURM am exempt from the provislons ot the State of Californie Business VALUATI ON antl Professions otle, Division 3, Chepter q Sipnaiure of �, �/� �+ . / � w ' Permlttae � u l. JV��C/ $ (/ I 1 Q / Authorizetl A nt DATE APPROVED � � m House 2190 m Garag'e 585 � !N UNDER VALUATION IS FOR m 'ABLISHING A PERMIT FEE ONIV : � PERMIT FEE E a � w PLAN CHECK E ^ � O LL TAX E � � p TOTALPAID S 3