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HomeMy WebLinkAbout848 SONORA RD - Building Permits�LN� � � �� INSUR�NCE POLICY NUM9ER . H011 8 9 3709 STANDARD TIME AT THE IG7 848 SONORA RD COSTA MESA, CA 92626 MARY JANE BELL 848 SONORA RD COSTA MESA, CA 92626 Homeowners Policy Declarations TERM (VRS) PRODUCERCODE 01 1462133 T �ORT A CLAIM, Ca111�800-877-1111 AGENT OR BROKER Inc Coverage is provitletl where a premium or limit is shown. Loan Number: 271287 CITY OF COSTA MESA 77 FAIR DR COSTA MESA, CA 092626 Other Insmed Location (No., SUeet, Apt, Town or Ciry, 5[ate 8 Zip): This Policy D�c� "Ict T_r.c'_ude Bu!ldir.g Ce.�',e Lp�ra3e ..eve�age. Age of Dwelling: 40 Years Earthquake Coverage Not Included - HONOS/1E601 Form372-NS Form438BFU-NS H000030491 H001040200 H004010693 H004960991 H029900193 HOE05/19E997 HOE05/15E997 HOE05/1E997 HOE05/3E997 HOE05/4F997 Inflation Protection Endorsement HOE05/BE997 HOE0523 HOE05/6E997 Replace[nent Cost Contents Charge £or Decreased Deductible HOE05/8E997 Protection Device or Security Credit Age Factor Increased Coverage E Limits Premium Increased Medical Payments Limit Charge HOE05/12E997 ExtendeCl Replacement Cost Endorsement Policv has been amendetl as follows: fA=ADDED D=DEI HODOS/1E997 O%/�O/O2 SEE IMPORTAM NOTICE ON REVERSE nL RETURN �.�� �.�� Mortgagee Copy CONSUMER PROTECTION INFORMATION - We may, as a part of our underwriting procedure for processing applications for insurance, or in updating or renewing it, order an investigative consumer report whereby information as to your general character, reputation, personal characteristics and mode of living, whichever is applicable, is obtained through personal interviews with your neighbors, friends or others with whom you are acquainted or who may have knowledge concerning of any these items of information to develop information. If such a consumer report is ordered, further information on the nature and scope of the investigation is available to you upon your written request. _ � :- Owner: Resident: Site Address: City/Zip: Pa�cel Id: L,ocation: Neighborhood: Legal Desc.: Usage: Style: Construction: Year Built: Stories: Bdmis: Baths: Heating: Cooling: Irr. Lot: Tertain: Wa[er. Sewer: Sqft ]st: Sqft Total: Market Value: Assessed Land: Assessed Bldg.: Assessed Total: Tax Semi Ann.: Sale Da[e: Sale Amt: Deed Type: Volume & Page: Seller: Title Company: Multi-Parcel: CITY OF ('(i��?STA MESA PROPERTY DETAIL� �PORT v�4i,i 848 Sonora Rd Costa Mesa, CA 92626-5708 Bell Mary Jane Bell, David Leslie 84S Sonora Rd Costa Mesa / 92626-5708 141-542-12 Cos[a Mesa City Unknown N Tr 4184 Lot 34 122: Single Family Residential Unknown Urilcnown 1962 Tot.Rms.: 1 Bsmt. Type: 4 Bsmt. Fin.: 2 Full Gar. Type: Unknow� GacSq.Ft.: Unknown Roof Mater.: Unknown Roof Style: Unknown Attic Type: Unknown Condition: Unknown Lot Dim: Lot Size: 1418 Phone: Phone: Tax Address: Ciry/Zip: Owm. Occ.: School Disnict: Census Tract 7 Unknown Unknown A[tached Garage Unknown Unknown Unknown Unknown 149 acres (714) 662-5967 (714) 662-5967 848 Sonora Rd Costa Mesa / 92626 Yes Newpor[-Mesa Unified 063904 Blktop Paving: Concrt Paving: Cacport: Deck: Pa[io: Pole Bam: Pool: F'veplace: Gas: Electric: $54,335 Gross Tax Semi Ann.: $22,245 HB920 Credit Semi.: $32,090 RB Credit Semi Ann.: $54,335 RBA Credit Semi.: $39124 Homestead Exemption: Spec. Assmt Semi.: Oct-17-1990 Mortgage Date: Mortgage Amt.: Other Mortgage Type: Volume & Page: Lender: Unknown Mortgage Term: N Mortgage Ra[e: Unk. Unk. No Unk. Unk. Unk. No Unk. Unk. $391.24 7'he inlbrtnation is decmed reliable bu[ is not guaranteed. 200I-2002 Tax Year Copyright 2002 Haines Printed Jul-2G-02 � --- PflOJECT A�OPESS: 8 4 8 SONORA RD � OWNEH'$NAME: BELL LESLIE - aoosEss: g q 8 �ONORA RD COSTA MESA,CA (714)546-1666 AflCNIENGINEEN: ' � . P�OPESS: ' uxir: 92626 flEC.NO.: UNIT: 'E"^"rTEE: RAINPROOF ROOFING ( 714 ) 536-8702 aooeess: 369 P.O. BOX HUNTIIJGTON HEACH CA 92648 LICENSED CONTRACTOfl DECt�1flATI0N: I hereby alfirm that I am licensetl under pmvisions of Chapler 9(commencing wiih Section 7000� ol Oiv�sion 3 of ihe Business antl Pmiessions Cotle, antl my hcense is in full �orce and efleci. , ciTruc.:049442 STPTELIC.:SS%'S �'^Sl;'�C—�9, /' , � �ate� S �// �9/ SignaNre. _���L � WOflREBS' COMPENSPTION UECLABATIUN: I hereby irm ihat I have a certificate ol consent to selbinsure or a certificate o1 Workers" Comvensaiion Insurance, or a cerufieA cooY �hereoi (Section 3800. Lab. C�. roucvxo.: 1182447-90 E%P.ORTE: O�iIOS�92 cornvaxv: STATE FUND , � Cer�ified c�py is hereby tumished. � Cerii�ied copY is IileA wilh the city B/uilOing /Orvision. oare: -�'i — �� ' — g� A000cam: �% �(.�i.l�� -. E%EMPTIONFpOMWONREHS'COMPENSATIONOECLAflNT10 . QhisseaionneeAna�becompleleUd�hepermilisfaronehunOred�5100)orless�. ' I ceriity Iha� in Ne peAormance of ��e woB �ar which Ihis permi� is i55ue0. I shall nol employ any person in any manner so as to become �I su��ect �o I�e Workers' Compensalion Laws of Calitomia. . Oaie: SignaWre: ' NO710E: II, afier making ihis tleclaratioq you shoul0 become sublect m �he Workers' Compensation pmvisions ot ihe Labor Cotle. yau mus� fori�wi�h comply with suc� provisions or �his permi� shall be tleemed revoketl. CONSTHOCTION LENOING FGENCY: I hereby alfirm �hai �here is a construc�ion lentling agency �ar Ihe pedormance ot Ihe work for whiih Ilris permii is i=.suetl �Section 3097. Civ. C�. LENOEfl: AODflE55: ' � OWNEP BII1LOEfl DECIABRTION: I hereby allirm that I am eKemp� �mm �he Conirac�ors' S�ale License Law for tAe following reason �Secti�n 7031.5 Business anU Pmlessional Cotle: Any ciry ol county which requires a permit �o constmci, alter. imprave, tlemolish, or re0air any Slmcture. prior lo ils issuance, also requires Ihe aDPlicanl lor suc� permi� to file a signe0 statement thai helshe is licensetl pursuanuo Ihe pmvisions oi Ihe Comracmrs' Sla�e License Law (C�ap�er 9(commencing with Sec�ion 7000) ol �ivisian 7 0� Ihe Business anU Professions Coee) or Ihat nelshe is exempt Iherefrom an0 ihe Dasis for Ihe allegetl exempiion. Any violation of Seqion 7031.5 by any applitam lor a permn su�lec�s Ihe applicam m a civil penal�y o� no� more �han �ive hundred�dollars (E500�. I. as owner ol ihe property or my empioyees with wages as iheir sole compensation, will do the work, antl ihe ❑ SlmcWre is noi intenAeA or atleretllor sale (Sec�iOn 7044, Business and Prote55ionalCode: The Con[raciors' Sla�¢ License Law tloes no� apply to an owner of a pwperiy wha �uiltls or impmves thereon. an0 who Ooes such work himself/herself or ihmugh his ar her own employees, provitletl t�a� such improvemenis are not in�enaed or o��ere0 fo� sale. I( however Ihe builtling or ' impmvemeni i5 soltl within one year o� completioq Ihe owner will have the burden ol pmving he/she ditl no� Uuiltl or impmve lor�he purpose of sale). I,aS ownero�ihe property.am exclusivety conVacting with Iicense0 conVac�ors�o consimctihe prolect(Section 7044; Business ❑ and Pm�essions Cade: ihe Canirac�ors' S�a�e LicenSe Law tloes not appy �o an ovmer of pmperry who builtls or impmves �hereon and who convacls lor sucli Wolecls wi�h a coniraclor�s) license pursuan� ta the Conlraciors' Sta�e License Law). I am aware Ihal pmol o� IAeir Worker'S Compensalion insurance ShoWd be pmvitled lo me. . ,� I am exempl un0er Section: B. 8 P. C. I, lor Ihis reason: oate' � Owner I tlo here�y cenity Iha� I am aware of antl understand the requirements ol Cali�omia HeaVh antl Salety Code Seciions 25505, 25533, and' 25594 ana Ihai I or any �ulure building occupant wAl/will nol (circle one) neetl �o comply wiN 5ai0 s�a�e�coees antl the requiremen�s far a permii lor con5lmciion or modificalion Imm the Nii Ouality Management �iSVicL ResiOeniial cons�mction applica�ions are exempt �mm Ne=.e U�ouisians. , • . �Oale: ApP�icanl: � I here6y cenity �hal I nave rea0 thls apphcatmn antl sta�e Iha� �he a�ove in�ormalion ls correcl. I agree �o camply wi�h all ciry antl wunry ortlinances antl siatelawsrelatingto builtling con5�mciion and aulhorire representalives ol��is ciryto enierupon�he above�mentionetl propertyplor inspeclmn pwposes. � Dale: " �//y�� Signal onver's�icenseorsocia�sewriiyx� 16GP46 White—Bmltling: Green—CoOe Enlorcement: Canary—Applicam; Pink—Revenue; Goitlemod—Fssessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO; H 053822 PERMIT,NO; B 053822 PLAN CHECK NO: N GOVT; N SUPP: N CONSTRUCTION TYPE; 5—N PERMIT TYPE; STR FURPOSE: ALT JOH DESCRZPTION : T/O OLD ROOF INSTALL NEW 30YR COMP'ROOF SQ FT: 5,674 • CLAIM VALUE: 5,674,00 CALC—VALUE; 5,674.00 GROUP OCC; R-3 /M-1 COMMENTS- SMOKE DETECTOR(S) RE�UIRED IN HOME�������5 /'C—,�%i�� *�����**i��*��r�r**�*��*rt�r�****** �*��r��r*�*�**� *� ���r*�r�r* �x�* � *� Z O N I N G R E Q U I R E M E N T S 9' //�9� S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT; FT IN REAR; FT IN FRNT; FT IN REAR: FT IN LEFT; FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN PARKING RE(� • PROV: PARCEL: 14154212 ZNE: REF NO; PLANNING NtST'ES> *x��***�e***�r�r* e'*�r�r***�r��t*�t�*�r�r�*�t�t�t�t*�t�t�t�t�t�t*�t�t*****�t�t***x�*�r�t*�t�t***�t�r�t��r**�*�c*x** 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 NoT S ZONING APPROVED BY DATE: BUILDING APPROVED BY ; DATE: APPLICATION ISSUED BY•� DATE: ' / % *****�*�r*�r**�r�r.****�r*�r* ��+�+��****�**��������** 1tiklFilikiFlkiFiFiFlkiflFififiElf#kiFiFififiFikiF�EjFiFkiE�t ikJE�fkifiEiEN�ik3f �FiFkiEiF�f�fiEil�fiEkiEik!liE3fikifjtlFlkiliFlfiFiEiFifif3klE1F LEGALIZATION;N F E E S U M A R Y STRUCTURAL SEGMENT;Y BLDG PMT PLUMBING ELECTRIC . MECHANIC FIRE SMIPbRES GRADING PERMIT 81.00 � -:;57 SMIP/NON—RES PLAN • ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS----> 81,57 0.00 0.00 81.57 81,5,7 ,00 �� REVENUE DIVISION TOTALS--> COLLECTED: 81,57 OVER/SHORT:.`' 00 BLDG PMT PLUMBING ELECTRIC.MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 81.00 .57 . )� ..' iFiF iE jF iE if if iF kiE If �E iF if �lF 3F �k iF iE if iE iFak iE if iE �f iE If 1! k iE iE iF iF if iE if if iE iF iF it iFif iE iF iF if iFlE iE iF if iE if iEiE iF iF �f iF IE IE iF iE jF fF 1F if iE if iE �F ff {(. iF IF jf ' I N D Z V I D U A L F E E B R E A K D O W N `' TYPE QTY D E S C R I P T I O N UNIT COST .�� TOTAL COST SFR 5674 REROOF BY VALUE RESIDENTIAL NOZONE . 1.00 5,67q,00 , END OF FEES �i ci anosE�ii-ooaesg:�L :��r� ���' &i.s:� DHTE: t79J12191 ?�S1E` 15�19 .�; ; � ; � -� CONSTRUCTION AND PLANNING � � POO :PA ' � ' APPROVALS Permit # � Date Inspector p�ppROVALS Permit # � Date Inspector 1.•Temporary Elect��ca� Servic`e or Pole , ' 52. Pool & Equipment Location :� 2. Soil Pipe-Undrgrnd. W a�; 53. Steel Reinforcement ,.13,�E�gctriral Condu Z ULilitY-Undrgrnd� �" 54. Forms .x.4.;•El�ctrical CondurtcUndrgrnd. `� �� 55. Electrical Bonding {'� S�=Steel i�einforce�enI' �- � 56. Rough Plumbing & Pressure Test n:dr�c:, �._ �- ��.��[ .11 � ��'� �v -'.) �'Sc.�lgctrncal UFEFi G!�1d. ;v 57. APPROVAL TO COVER�GUNITE H1�7(UFaotin�s .^�'y� ^• ' . 58. Electrical Conduit-Undrgrnd. ,r. �-.n. a' B. Foundation Y;� �j ` 59. Gas Pipe, Q Undrgrnd., Test 9. Water Pipe�Und�grnd. 60. Backwash Lines, P-Trap, O� Undrgmd. 70. Structural Floor SYstem '. 'a � 61. APPROVAL TO DECK 11. Pcoperty Sewer Linc:& House Connection , 62. Backwash & Receptor-Pinal 12. Se�',wer Cap _ y y � 63. Heater & Vent-Final �, . 13. Roof Drains � 64. Plumbing System - Final 14. Rough Plumbin� '^ ` 65. Electrical-Final 1.5. Rough Electrical�Conduit 66. Solar System-Final � 16. Rough ElectricdNiring . 67. Fencing & Access Approval � 17. Raugh Wiring Si9n 68. APPROVED FOR PLASTERING _ 18. Rough Eleciric9f-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL �: 79. Rough Heating & Air Conditioning �� - � - - FIRE DEPT. REQUIREMENT ' 1S L����y:,, ' 20nRoe{gh F�ctory F:aeplace � i�v; eC �.v =ic a¢1ppRO:VAL'S:;^.(.Permit # �•� .i ...� ..rr, � ::., er . �si-c�- -. �� 21 sDuc't�,�t, i�Str'yctu�.e r i'y .. :y�, :� j ,�:;�; y; 570. l7nde giyun`c�j Hydro �n 22. DucKs, Ventilating�z � Cj� x � S �LY :> � 577, product*P.�ing ��tCi�s O'Oil 23i-Gas Pi e�Rou h&'Test � x 1 �' � •'�� �_7g, Under io �1 Fl�y '� r. P 8 t �vS ....y i;� �' 9 1�. ;�5���% * 24�aRoo� Framing• :^� � ;--; �i-�• r � - C ��x � 73!nUndergrntieStorage�Tank'OGas OOiI ::n. � ti r ll�' � S O �-� _._. a 25. Roof Sh�athing ��Y ,� ,� ���- ;� ��(,U 74..Qverhead Hydro-.' � ` 26`7-Bar Ceiling (S��yatural) &�Aonecoat + „- _ �y:r x 75LTDry Chemical J - r'.�; 27?Frameand Flash'� 'A�T~ �� � � u w 76ED�y Stand�it'�e ��} Y� •� 'n �-� c., �v c �)�.:'0. .« 7' r S:. •- rT r O 4t / �]C '�i=i(J - i� M:.- � . .tl-. t �...' .� �3 .28. Lat�ing-& Siding-.x r.t ^�yt;; �x *7' •�:� s 777'FIXED SYSTENL'F'INALx ��' .. .. y29. Insulation �a. U': ` � •• •' '' �� 17 j- ,.�: `K 7gz.FIRE PREV. FINl�L '� ; i;,• �: J-30. Drywall aiVmg `--* � �� j� �� �.yt R w HEALYH:DEPTeREQUIREMENT - ' i � r,31. Plaster &owqCo�i i r�.�. ,� i �_5�; r.79:�INAL If�$2ECTION ,- 'T ;� " `� � �„ i � ` . � � ;f'��'a.y z80:,FOOD CEF2Tr�IFICATE ISFI'IED �� ��32.�Electrical Power �et rFinal ' : p� .33.�Fina1 Electri. �' . ' �' '�. �r 1 �� h� ', �. :'Noi s: =' =�: :i_ ' - iri C �n r4 �ri i eL # � y .� ' ;ni �-7 n�p] ;,`�,34..-Fin�t H2ating & �r',G�onditioning� � ,�, `'�' ! -� r � � Y t-,'-'�t � S ;]� r .� `35,�Finai Gaf Pip�-7esiy � �uf = z . { � � x +. " � iq S :t: t�� �; C, •: 7 2r �.-• x '-.tn T ' : f • • -4� �� .� 1 ..i� "� . .n 36. Hood or`Cano v � -, ,-� _� % ' ' ,y �� P O _ � t :. C� � r��, .,'�R :-. s, r ^ p ,,� „- ,37.CFinal Factory Fireptace.,,� ! �;� � �� ,Y �`= � , ��R�j.^ � '^ t�i 'f' � � :� _'38. FinaV Plumbing�/Y ,��� � .. .. 4 :e �� � �, , T � {" � � i ; /� .:t. �S i-� . �.r.. J : 39. Water Service-Fina`l= '� � �� x� � i'�' '� C' ra�:� � o; r .r � 4: s �•. tK t 1 ?!k +?� y� °40. Gas Ser e�Finel' � , �'' r ; t "'. - �' x ," '"- '4� �-.x t� ¢t�`?^ S +!<' ,� k rvn; �7. Solar pomestic-F-+n`al:s ;� " 't � I I � _. v;.`� ' ^ /: `i R• t+ .t• 'li- Y [ `-"42.�Backflow�PreventeT �� *J � � I ! h t �R >F ` _ S � • � '� . � . .�.-,.� : . . �-_ .� . 43. Backflow Irrtgation' '�= =� �� � � "� cc;:�; y ._ �: Y ry" :' ;: / .. i.tf: 'Y. r �. .. (:l :r ' �n44. Landscape lirigation Systemi;:7� . � x �. - ,_,.... r ��7 � �1 J :1: �: i �U J :�5.'Sound AttenLatipn: , ,� - � �r. ?: i- i- c.-�.; :>. '� �� rt :- ,;;,y : " ` r .�r > �r. �t X. � -` ef � �y, ' ' 'e rr .t Y: � . / ..�� _ U C'46.� Hand'+cap,Regulatm�as :, - x ' ' .. ,, ,- , ',L_, ' -;/ �, Y�- 47:; FIN'AL STRWCfiIjRE & BUItDING �� �<6-Gl� �(�% _' � i5.- �. " � ,748 �'fIN;A� PLANNING� , ; ".r° > ( � ��.'� q " °' �� • F.�-, ;n �' /ik. T! r, +, -.:49r..�Elec[ric Release to Ediwn r ' ' i, 4.K > i� � � t i�e �?.. � I i✓ n Y� n s �50.,.GasyFelease to SoGfhefn Cafifornia GasCo � i � S ''� . ''�h ; `� '�, �. . �� i ;-51.�CERTIFICATE�OF"OCCUPANCY , :� :; ` �� �.�; , ;, " � No. Date l; OWNER JOB ADDRES: GENERAL CO�. AP No. INSPECTIONS OCCUPANCY 0 �'r•r,, Leslie & LOT Jane TRACT hl Rli FIRL 7.ONE DATE I GROUP VALUE $ 250, D�SCRIPTION OF TYPE v SUBCONTRACTOR 7.ONE & S. l, ,,:.�� ���5z COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 817 COBTA MEBA. CALIFORNIA For Applicanf to Fill In Complefely YYPE OR PRINT BUILDING U ADDRE55 /J COSTA MESA. CALIFORNIA ■ MAIL ■ wacH�iecr �FE ' �RECEI V�d � APR 2 �� FINAIYCE DEPT, CITY OF CJ�TA MESq APPLICATION FOR PERMIT BUILDING TFor Office Use Only � n@CEIPT NO. � �/1�0. I V L J!Y I OATE RECEIVED � AATE 185I1ED ys�sez��� TEL. BUILDI� q-�� /'It' NO.S 6"I � pDORESS �� C/ /�• i� (.Q.�+ / rE�. COSTA MESA. CALIFORNIA NO. FIRE // ZONE TYPE V GROUP /�}.� / � NO. OF BIDOB. OP LOT (7 `cL_V/ J v � NOW orv LOi I � BQTBACK LINE PNOM DESCRIPTION OF WORK NO. OF EXTERIOR WALL GOVERING USE OF BUILDING i HER6BY ACKNOWLEOG6 THAT 1 HAV6 REAO TH�e MPLIWTION AND BTATE THAT THE ABOVE I6 GORRECT AN� AGREE TO'COM- vLV WITH ALL CITY O�INANCE6 AND BTATE L�WB R80UUTINO eu1LpIN0 CON9TRUCTION. 81GNATURE OF ��� " ��� PERMI'RE� � � � v AUTHORIZED AGENT APPROVED ZONING Ho.ov use ov n PLANS y BUILDING YARDS EVES APPROVED ALLO fCENTER LIN¢ eTJ �/I ��... THE AMOUNT SHOWN UNOER VALUATION IS FOR THE PURPO6E OF EBTPBLIBXING A PERM�T FEE ONLY. VALUATION ,�/� PERMIT FEE $ �� � / �% S �i D PLAN CHECK $ F 0 LL �� � ._ � r .,. � �`:tQ� I �C COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 917 C08TA MEBA. CALIRORNIA For Applieanf fo Fill In Compleiely TYPE OR PRINT " ADDRE'S6 848 Sonora Road COSTA MESA CALIFORNIA ■ ARCHITECT TEL. NO. TEL. cin Corona del Mar, California LIC.TNO. 9HHOH SB -1 TNO. OR 34220 � oF �or 6500 SF nluc I r�+ow ow oia' USE OF • EXISTING BLDG. NpRC' � 86TBAGK LINB FROM cerfrex oc eTneer �- V REAR YARD � SIDE YARD I LEFT S� I RIGHT S� DESCRIPTION OF WORK BUILDING NO. OF SIZE �nX3� � -in�� ROOMS PXTERIOR WALL BYICIC,IROOF Shingles FEE RECEIVED � JUL 121961 FINANCE DEPT. CITV OF COSTA MESA APPLICATION FOR PERMIT BUILDING For Offiee Use Only RECEIPT NO. •� P{qMl7.NC '1l !a M / 1'xl] � ReGE1V� BY I DAR RECEIVED I DAT6 183U! FIRE COSTA MESA. CALIFORNIA ZON1ING y/ I NO. OF 'j yUBE OP N l vuxe �/' BUILpIN6 (GeNTlR 4N6 8T.1 —�l- C Sin le famil residence Living Area - 1245 SF w attached ara e Garage Area - 390 SF Cov orches - 110 SF 1 HEHEBY ACKNOWlPD6E TNAT 1 HAVE PEAD iX18 APPLICATION }ryE AMOUNT 6HOWN UNDEP VALUATION 18 FOH TH! •NU BT/�TE THAT TN! A60V6 18 CORReCT AND Aaf168 TO CON- pUliP096 OP EBTAlL19XIN6 A PERMIT FE¢ ONLY. r�Y w�Tef wLL CIiY OROINANCEB AND BTIITE LAW6 p84UUTINO BUILDINo CONBTRUCT1oN. ' VALUATION � 81GNATURE OF PERMIT FEE $ �� PERMITTE / $y ' '�Do S 13�1(�'z.Q� PLANCHECK $��O � AUTHORIZED A /�„���WLL�f " ' / G?B R O LL