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Home My WebLink About2245 STATE AVE - Building Permits CITY OF COSTA MESA • CkP" BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT PERMIT NUMBER JPO4-00131 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 • PLUMBING PERMIT Job Address: 2245 STATE AV Status: ISSUED Suite No Applied: 02/25/2004 Issued: 02/25/2004 Vicinity: Parcel Nunmber: 42207224 ISSUED BY: Applicant: WASHBON, CINDY Address: 294 MAGNOLIA Phone: 949-548-9783 COSTA MESA,CA Zip: 92627 Owner: WASHBON, REID TR • Address 294 MAGNOLIA Phone: COSTA MESA,CA Zip: 92627 Contractor: - - Address: • - Phone: Zip: License: Arch / Eng: - -„ - • ' Address: Phone: • Zip: -� - - - License: , - - ., • SCOPE OF PERMIT REPLACE LATERAL ON SITE TO EXISTING DUPLEX • .FEESUMMARY, AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 • 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 $24.65 1 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. 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 $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor - . $0.00 - 0 Water Service $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) 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 2446-46(6/00) DECLARATIONS (J (l WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: , ❑ 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. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Cage,for the performance of the work for which this permit is issued. My workers'comper)sation Insurance carrier and policy number are: Carrier: I Policy Number: his eon need not be completed it the permit is valued at one hundred dollars($100)or less.) , T 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 aliforr`la,and agre that if I should become subject to the workers'compensation provisions of Sec on 3700 the Labor Code,I shall forthwith comply with these pr Ions.�/ 1R� q ,� �, �� O� Applicant Signature: l -zz �i1./GG�U`-(T/'r' x Date: Lc' WARNING:FAILURE TO SECURE WORKE-•0 PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIE AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,0001,IN ADDI • TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR 0013E,INTEREST,AND ATTORNEYS 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.LIc.# Class# Contractor's Signature: Date: 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 penally 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 fore 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.). • 1rI,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 pursuan to the Contractors License Laws.). ❑ I am exempt er e . Business and Professions Code for this reason: n (2_ s /es -1!"\ lnauDate: CSC/ Owner ID verified by driver's license es 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 6,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: 1 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 t0 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 implication apennit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LJ 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? ❑Yes 0 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 prescnbed by California Health and Safety Code Section 42303 been made? 0 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. 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 scribed property Or�nspection purposes., rposes.I agree not to occupy or allow occupancy of any building authorized by this perrgit until final inspection. �/USiigggnatt)ure 0O1LegalOwner(s) >tate U And/Or Authorized Applicant Date OODE I 1N$PECTIONTYPE PATE IflTR1AL$ LODES IISPECTION TYPE PATE =Ma 1616 Fixed System Final Fire Prevention 206 Final Mechanical �x 1266 Pool Spa Final 208 Final Plumbing - p/-n2.S-0'! 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 lilADDRESS OF BUILDING: 2245 STATE AV UNIT: DfINERSKAMENKNON'K: WASHBON, REID TR FLOOD: AE-37 CITY OF COSTA MESA — BUILDING PERMIT 306 PERM NO: B 081 muREu 294 MAGNOLIA ' COSTA MESA,CA 92627 PERMIT NO: B 083306 PLAN CHECK NO: N GOVT: N SUPP : N 645-3977 . APPL.MAIUNG ADDRESS CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: 0TH ARCHRECT OR ENGNEER: MHO.: JOB DESCRIPTION : T/O & COVER W/2 #15LB & 25YR COMPSHINGL SQ FT: 5, 107 ARCH.OR ENG.'S ADDRESS: UNIT: CLAIM VALUE: 5, 107 . 00 CALC—VALUE: 5, 107 . 00 GROUP OCC : R-3 / CONTRACTORSKAME: SENTRY ROOFING CO ( 714 ) 751-7663 CONIRACTORSMNWW 3364 NEVADA COMMENTS: RESIDENTIAL REROOF ADDRESS: COSTA MESA CA ucNo.: 678801 ***** * **+E*x*>EK******ar****>F*M***m********SE*******x*****x*x***SEM***>E +tx*aE>c*+E'*** 92626 we: ZONING REQUIREMENTS UCENSED CONTRACTORS DECLARATION:I hereby ahem under penalty of perjury that I am licensed under provisions of Chapter 9 SETBACKS (commencing with Section 7000)of Divlsln 3 of the Business end Professions Code,and my' is in I&1 home and effect. Cm UC.NO.: 060429 LIC.CLASS: C-39 arc. o.:, M7880 : 01 /98 MAIN BUILDING ACCESSORY BUILDING ---- Dae. g, 4t FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN � '�h 97 °out`s°« LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION:I hereby affirm under penalty of perjury that I am xempt from the Contractors License Law f«the rolmwing reason(Section 7031.5 Business and Pmfes ions Code:Any city or county which requires a permit to caMm c,alter.improve, PARKING REQ: PRO V: PARCEL: 13957216 Z N E: REF NO: emorepairish,or repair any structure.prior to ifs issuance.also requires the applicant for such permit to file a signed statement that he or she 7 e licensed pursuant to the provisions of the Contractors License Law[Chatter 9(commencing with Section 700))a Division 3 of the PLANNING NOT ES> Business and Professions Coder or that he or she is exempt therefrom and the basis f«the alleged exemption.Ary violation of Section D 7031.5 by any applicant for apemtit subpds the applicant to a civil perWlyd not more than five hundred dollars 155000. **,**k******itlt*. X)f kk*iE1FjFRE1F****dki ****1f**:If**jE{(.x.g!•*jEN.*.3EfE{t3(.{E.7(.dE7f.)4.x.7pf(.{E*.1EK.�(.x.K.K.M.-7f*1EM.*.)t1 *** ❑ I.as owner& per the opy or my employees with wages as th.i sole compensation,will do the work,and the structure not intended D E V E~LOPMENT S E R V I C E SR E QU I R EM E N Ji? S . or offered for sale(Section 7044,Business and Professions Code:The Contractors License law does not appy to en owner of property L who builds or improves thereon,and who does such work himself or herself or through he or her own employees,provided that such , improvements are not intended or offered for salt It however,the building or imprevemeM is sold within one year of completion,the ZONING ownereuiterwilthavetheburden&proingheorshedidnotbuildorimproeforthepurposeofsale). ZONING APPROVED- BY DATE: 7 . ❑ I,as owner of the property,am exclusively contractkg with licensed contractors to construct the project(Section 7044,Business and ' Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon and who BUILDING APPROVED BY : DATE: contracts for such projects with a cMreaoris)licensed pursuant t the Contractors License Law). f ❑ Iamexempt //under Section: B.aP.C..f«th APPLICATION ISSUED BY : / cDATE: - rcc ** Det.: 4 / —91 amt: x —.. **********it***'it******* *********s **Tf1 *W****rf*. * Fy J *************#* * LEGALIZATION:Nit F E E SUMMARY STRUCTURAL SEGMENT :Y I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and - a pannandthatlprany future bciltingooahentwill/wDnot(acb°ro)roedtoc«nply wiheaidstatecodosand theemptfmrtese BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRAD'ING a par4, stdor th t I or ian«moe?mion occorn pant r�ty otegemeot ei nit a toecompyl ooh said st to co es n thre e Tempt eme tts f r provisions. PERMIT 112 , 2551, Date: Applicant: SNIP/NON—RES WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty d perjury one of the following declarations: PLAN ❑ Ihave and Amntaeecetavo teconsenttoseU « : .insurefworkerc°mpensation.asprovidedforbySeai°n3700othe Labor ISSUE FEE dL Code,f«the purformanceof the work for which tnlputmteesud. BUILD'S NG DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ Ihave and will maintain workers' v compenslninsurance,asrequiredbySecion3700& m theLaborCode,forthepermanceofth. TOTALS----> 112 , 76 0 , 00 0 , 00 112 .76 112 , 76 . 00 work for which this panni is Sued.My workers'compensation insurance ceder and policy number are: Carder: REVENUE DIVISION TOTALS--> COLLECTED: 112 , 76 OVER/SHORT: . 00 Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING 'PLAN—CHECK Y(�Thnis section need nor be completed t the porta is ler one hundred dollars/ale0/or less.) 112 , 25 . 51 U I deify that in the performance of the work for witch this permit is Issued,I shall not employ any person in.'manner ens to becc°e subject to the workers' laws d California. nd reetel it - • I becomes /• tothe workers' ****************************************X-*0****************#***************#**** ocogenahastp�fan sea 37ao&the ab«ca..len fans /•--pa ui• ,.i I N D I V I D U A L F E E B R E A K D rO W N �i Dale: / Applicant: �! Warning:Felon to secure wortsrironpensaton coverages unlawful,and shell subject an mph* to criminal penalties end TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST civil fines up to one hundred thousand dollars(St04000A/n Athertonto the coal of compensation,damage.a provided for in Section the and SFR 5107 REROOF BY VALUE RESIDENTIAL NOZONE 1 .00 5, 107 , 00 CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that there is a coMnMion lending agency for the END OF FEES performance of the work for which this permit is issued(Section 3097,Civ.C). LENDER'S NAME: LENDER'S ADDRESS: I certify that I have read this application and stale that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction and hereby authorize representatives of th' city to enter upon the above-mentioned properly for inspection purposes. LARRY SWORD • 06-16-1997/02:33 0Vf112776 :PERMITen3396 L/! i� 1 % / Date: .inflator()• •T.T/Agent/A•g"i i'ontrecty! (5151-a8 WP) White-Ouildkg 8 Safety:Green-File:Canary-ApplcanC Pink-Revenue:Goldenrod-Assessor 4 CONSTRUCTION AND PLANNING • - - POI SPA APPROVALS Permit# Date 'Inspector APPROVALS Permit # Date Inspector • 1. Temporary Electrical Service or Pole - 52. Pool & Equipment Location', - �i 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement ' . - . . ' 3. Electrical Conduit Utility-Undrgrnd.. 54. Forms' • i 4. Electrical Conduit-Undrgrnd. . 4 • 55. Electrical Bonding 5. Steel Reinforcement 56: Rough Plumbing & Pressure Test i 6. Electrical UFER Grnd. - - - 57. APPROVAL TO COVER-GUNITE • 7. Footings 58. Electrical Conduit-Undrgrnd, - i, 8. Foundation - - 59. Gas Pipe, C Undrgrnd., Test - i 9. Water Pipe-Undrgrnd. . - /V. 60. Backwash Lines,P-Trap, D-Undrgrnd. i . 10. Structural Floor System J - _ iii 61. APPROVAL TO DECK �Jr ' - 11. Property Sewer Line & House Connection 7• 62. Backwash & Receptor-Findl/-, 12. Sewer Cap .j - -. • 63. Heater & Vent-Final -..- 13. Roof Drains /' N - . . 64. Plumbing System - Final 14. Rough Plumbing '-, 65: Electrical-Final - 15. Rough Electrical-Conduit • I . ' .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 0 Gas 0Oil 23. Gas Pipe-Rough& Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 6-4--q76- A• 4. 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 INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 1 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 40. Gas Service-Final 41. Solar Domestic-Final 1 - 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations it, '71 47. FINAL STRUCTURE & 9UALD1NG 20 c�j/:c1'// ;:...4 48. FINAL PLANNING -"� it 49. Electric Release to Edison . ,y i ' IL 50. Gas Release to Southern California Gas Co ::-;•-I 51. CERTIFICATE OF OCCUPANCY .r F.2 k v - No Date • 12524 FEE RECE ,VED COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 917 COSTA MESA. CALIFORNIA FINN ANCE DEPT. For Applicant to Fill In Completely � CITY COSTA MESA PP P Y APPLICATION FOR PERMIT TYPE OR PRINT iT TE UILDING BUILDING B ADDRESS 2245 Avenue �� COSTA MESA. CALIFORNIA For Office Use Only RECEIPT NO. I PERMIT NO. OWNER Columbia Homes, Inc. �§y('.� /q 2 Al MAIL RECE . Y- D7 // _- o I Wt[TE`,1� p.( ADDRESS 1533 Baker Street e ]N�+ TEL. BUILDING CITY Costa Mesa NO. KI91151 ADDRESS ARCHITECT Carlon & TEL. COSTA MESA, CALIFORNIA OR ENGINEER MjRril ohrnnjr NO.LF9771.7 ADDRESS Garden Grove, Calif. FIRE e ZONE TYPE GROUT CONTRACTOR Dike & Colegrove, Inc. APPROVED DATEiJL 7 I ° J l ADDRESS 1533 Baker Street //1� ZONING ,4ti(.�/ �/ 2q — / NO.OF I .3.us., OF 'tire CITY Costa Mesa, California (I(// FLANS ?/ BUILDING STCTN o. 167293 TEL. KI91151 LEGAL P / �- DESCRIPTION Lot 2 T SIZE NO. OF BIDGS n OF LOT 60 x 115 NOW ON LOT none A.P.NO. rlti USE OF YARDS VVEV__ES EXISTING BLDG. none .moi APPROVED ALLOWED SETBACK LINE FROM (CENTER LINE BT.) //�-I CENTER OF STREET 401 REAR YARDC351 FRONT i/ FT. IN. SIDE YARD I LEFT 51 I RIGHT 51 4 R.SIDE / FT. IN, DESCRIPTION OF WORK L.SIDE 5 FT. IN. NEW I x II ALTERATION I II ADDITION I REAR 3 5--SFT. IN. REPAIR II MOVING I V DEMOLISH BYPROVED ( kJ L\ ` DATE - -o a NO. OFs ZE DING1758 so.ft.ROOMS _10 STORIES 1 ` ...it EXTERIOR WALL ROOF COVERING STUCCO COVERING Cnmn{ USE OF BUILDING AND WORK TO BE PERFO MED Miltiplo family dl7clli:€ ,with attached garage (two livinn 'units) Gar. 420 sq. ft. Plan AR 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 OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION (/�Y//��/.//,�(��y VALUATION PERMAITTEF OF(...--a/24,07,4_______ Fv �' " "I� PERMIT FEE $ 37.00eu S 17,926490 PLAN CHECK S 18.50 .1' AUTHORIZED AGENT Dike & Co grove, Inc. 5550 el TOTAL FEE . E