HomeMy WebLinkAbout007-340-029`��y, �.�� `. �__1 � � __ -- -_-�. .. _ • .'Y -__. �t�+�� -�C-�� ,ter �� �_w . .�..��� -� ...��.. . .�.
F009- 3q0-029
F*FaDrake
3101 Coronado Rd., lot 96, Joshua Tree
Permit#38 ;78B(new single family).
C
PerAt #7273-78B(0 clearance
I� ,
fire oxace) SF
L
0
�' �
O � M d'
�• ae:_i: L:�� ii_l,d
r'
rce (s)S_ce and/or W er pndjor-..3!ition Cl--
°LOCio.i _
'ter, sup?ly�
are c7i7r(�Ved iii Sew-o`-
up fi r.al "br: Water supply
Fin_? Clear 2rce ok fo- . __er "Su ply
bedrooms (^o�Q o� � i � -,o-�) - Oth-e
�C�:w.r".e is for a--- --
will be
E RLS E T
COMPANY
LICENRED CONTRACTOR
Insulation —Weatherstripping — Accoustical Tile
(Purchaser)
P: 0. Box 3506
Chico, California
Phone 342-4764
rete
�LLL /,--�
(No. and Street)
(City and State)
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATIONS, CALIFORNIA ADMINISTRATIVE CODE, TITLE 25,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:
Street Lot Number Tract No.
EXTERIOR WALLS
Manufacturer Thickness/Typeo�(� R Value
CEILINGS
Batts: Manufacturer Thickness � R Value
Blown: Manufacturer Thickness 11/ �JNo. Wt./B3i�
Sq. Ft. Covered /1j V R Value
FLOORS
Manufacturer Thickness/Type R Va!ue
SLAB ON GRADE
Manufacturer Thickness/Type R Value
Width of Insulation Inches
FOUNDATION WALLS
Manufacturer.
Thickness/Type
R Value
( DATE)
ACCEPTED
SAVE ENERGY - INSULATE!
H TH C®MPANY
(Authorized Representative)
PERMIT N0. 38.10-78844
.
t V
PERMIT EXPIRES / ^
I Dan Drake
OWNER
CONTR. owner
t
LOCATION (A.P. 44-43-18 port-
3101
orr_3101 Coronado Rd-, lot 96, Joshua tree#2,
Chico
f
'S
r
7
7
Temp. Power Pole
Called PG&E
Temp. Elec.yServ.
Cal,,,lee/d''PPG&E
Tern � Gz s Serv.
Called PG&E zz z
J0B
FINALED l
(Date)
(Sig t re
'r c
COUNTY 6F, BLrrTE — DEPARTMENT OF PUBLIC WORKS
BUILDING INSPECTION RECORD
BUILDING
BUILDING (Con ')
PLUMBING
Setback
Firewall
Soil Piping
Forms
Parapets -°
1st Floor
Main Bldg.
Restroom Finish
2nd Floor
Footings
Windows -.—""�
3rd Floor
Stemwa I
Siding
out ✓
Slab ✓ �'
Roof Sheathingater
Pi p in
Piers
Roofing
Sewer
Garage
Fdn. Vents
Fixtures
Footings
StemwaII
Garage Vents
Insulation
Water Htr.
Heaters
Slab
Carport
Footings
Slab
Prov. for ph ys cally
handica ed
Conformance of ex.
structure
Final
Appliances
Gas Piping & Test -� .
Temp. Gas
Sanitation
PatioFIREPLACE
Final .=
Footings
Footina
ELECTRICAL
Masonry Walls
Throat c,Rou
h -�
Reinf. Steel
Final
Fixtures
Bond Be
FIRE SPRINKLERS
Motors
Framing _
Test
Water Htr.
Stucco
Final
Subpanels
Mesh .-r
MEC NI
Grd. Fault Prot.
Scratch
Heating
Service
Brown
Y
Cooling
Temp. Pole
Finish
Interior Lath —
Ducts
Ventilation
Underground
Permanent
Door Closer
Final —
Final �
MOBILEHOME UTILITIES
------------- - ----
Elec- Service
Elec. Pedestal
Water Piping
Sewer
Gas Piping
MQBILEHOME INSTALLATION
- - - - - - - - - - - - - -
Support
Elec. Continuity
Water Piping
Drainage
Gas Piping
DATE
REM K R CORK TIONS
(NOTE: An entry must be made on this form each time you visit the job site.)
41"f ,r� COUNTY OF�BU,TTE - D�PAR TMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965
Telephone: 534-4541 3h��
APPLICATION AND PERMIT
�yz
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
<:2 .0 -0)
a4l
X Date
Signature of P rmi r Agent
Receipt No. J % f<
White-D.P.W. - Yellow -Assessor - Pink -Inspector - Goldenrod -Applicant
This permit is hereby issued under the applicable provisions of
the Butte County Code and/or resolutions to do work indicated
above for which fees have been paid.
DIRECTOR OF BLIC WORKS
By Data, / X, ?
Beding'permit expires Date
BUILDING
Owner
SQ. FT. OCC. BUILDING VALUATION
[> 99 00. ors 6
Mailing Address Atgo?U
O— 0nQ
Ch LC d
Telephone No.
$J
Q 0
Contractor L�
Mailing Address
Fireplace
Total Valuation N 60
Telephone No.
Permit Fee ;
Building Address St
Plan Checking Fee&/or Penalty
Permit Fee J/5 -10C)
Q�
Q (Aoronado Id
PLUMBING No.1 @ FEE
PERMIT FILING FEE $3.00
Each Trap 1.50
J e .a
Repair drainage or vent piping 1.50
-�
A. P. No
Water piping 1.50
Each gas water heater or vent 1.50
F s
t_:5:
n I FireDept. FireZone Use Permit
Gas piping system 1 -5 outlets 1.50
EQA
Parking
plans
Parcel
Declaration
Parcel Map 60' R/W
Improvements
Each additional outlet .30
Building sewer 5.00
Idg�g`ans ec
Parcel oyal
Plans A povol
Lawn sprinkler system 2.00
NEW ® ADDITION ❑ UTILITIES ❑ OTHER ❑
permit Fee $
ELECTRICAL No. @ FEE
PERMIT FILING FEE $3.00
Main service 600v OR LESS
100 AMP OR LESS 5•��
Single Family Duplex ❑ Mobil Home ❑ Others ❑
Main service EA- ADD•L 100 AMP 2.50
Main service OVER 25.00
100 AMPP OR LESS O
Main service// EA. ADD'L 100 AMP 1.00
NEW OR ADDNST l ACCLBLDGSLING CCUP. s) 22 sq ft
CONTRACTORS LICENSE LAW
I am licensed under the provisions of Chapter 9, Div. 3, of the
State of California Business & Professions Code under the name
style of:
MULTI
NEW R.S,D. BRANCH CIR T
NEW CO I T `BRANCH CIRCUITS) 2.50ea
NEW CONSTR. (POWER APPARATUS B
NON-RESID. SINGLE OUTLET CIR.
Ex. OCCUD{OUTLETS OR FIXT11RES BAL 0"100 1
FIXED APPLNS, OR
Ex. Occup. OUTLETS (RESID.) EA) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
License No. Classification
Misc. Wiring 6.25
I am exempt from the Contractors License Laws of the State of California.
Permit Fee $
$
MECHANICAL No @ FEE
WORKMEN'S COMPENSATION INSURANCE
1 am aware of the provisions of Section3700 of the California Labor
Code which requires every employer to be insured against liability
for Workmen's Compensation.
❑I have placed on file with the County of Butte a certificate of
Workmen's Compensation Insurance.
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 Workmen's Compensation Laws of
California.
PERMIT FILING FEE J$3.00
Heating
Cooling
Ventilation
Hood 2.00
Permit Fee $
$
1 certify that I have read this application and state that the above
information is correct. I agree to comply to all County Ordinances
and State Laws relating to building construction, and hereby
Land Development Fee
$ CIC
TOTAL PERMIT FEE
$ ®`
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
<:2 .0 -0)
a4l
X Date
Signature of P rmi r Agent
Receipt No. J % f<
White-D.P.W. - Yellow -Assessor - Pink -Inspector - Goldenrod -Applicant
This permit is hereby issued under the applicable provisions of
the Butte County Code and/or resolutions to do work indicated
above for which fees have been paid.
DIRECTOR OF BLIC WORKS
By Data, / X, ?
Beding'permit expires Date
•J•D 5�-lL.1 �
This set of plans and specifications MUST bo
kept on the job at all times and it is unlawful tq
meke„a erations on same withoyf
written permisson from the Department of Pub U
Works, County of Butte.
NOTv. 7II K40+e
rials & Workmanship Shall. Be in
Accordance with Recognized Good Practices and
of a quality prescribed for the Specified use in the
Uniform B ilding, Plu ahing & Machanical Codes and
the Natio al Electric I/F-3deAL% ! - /Z EV. — / C ..
N N
c
f
1
ic e? d�
\r9�ke
J
4u�Ce
k
a
f
THe-V .''SeJbjrc- `sfiaII be 5�t: from the
side pr perty line and 50 ft. from the
centerlic a of the road, permitting a mini-
mum of a 2 ft. eave overhang. but entirely
out of p1l easements. 76.24
o{ bv'`� e<
c8k`°r 2 35 PRS
1\a"\d v,, -'° DePt.
uN/7- -# 2
sp
BUTTE
ILDING
APP
$cr p��an on dile lor. ilwo*
see qas_ B_..
tura) de}oils• -
r-
io -756'
EPARTMENI
VED
• COUNTY OF EXTE- DEPARTMENT OF PUBLIC WORKS
7 County Center Drive — Oroville, California 95965
_ Telephone: 534-4541 ? y�
APPLICATION AND PERMIT
BUILDING
Owner SQ. FT. OCC. BUILDING VALUATION
Mailing Address
Telephone No
Contractor
Mailing Address
Building Address 3
A. P. No. --L Zoning & Planning
F re Dept. Fire Zone Use Permit
EQA..• I ParkingI Declaration p p Parcel
Plans Parcel Ma 60' R/W I Improvements
Parcel Approval I Plans Approval
NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER n®
t ► �u. s ti.c'1 wr �� o:t V1, 1 FN X
Single Family9311"- Duplex ❑ Mobil Home ❑ Others ❑
CONTRACTORS LICENSE LAW
I am licensed under the provisions of Chapter 9, Div. 3, of the
State of California Business & Professions Code under the name
style of:
License No. Classification
❑ I am exempt from the Contractors License Laws of the State of California.
WORKMEN'S COMPENSATION INSURANCE
I am aware of the provisions of Section3700 of the California Labor
Code which requires every employer to be insured against liability
for Work n's Compensation.
ave placed on file with the County of Butte a certificate of
Workmen's Compensation Insurance.
❑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 Workmen's Compensation Laws of
California.
I certify that I have read this application and state that the above
information is correct. I agree to comply to all County Ordinances
and State Laws relating to building construction, and hereby
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
xDate
1 nature of Permitee or Agent
Receipt No. t -
White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant
Fireplace
Total Valuation
Permit Fee
Plan Checking Fee &/or Penalty
Permit Fee
PLUMBING
PERMIT FILING FEE
Each Trap
Repair drainage or vent piping
Water piping
Each gas water heater or vent
Gas piping system 1 - 5 outlets
Each additional outlet
Building sewer
Lawn sprinkler system
Permit Fee
ELECTRICAL
PERMIT FILING FEE
Main service 600V OR LESS
100 AMP OR LESS
Main service EA. ADD•L 100 AMP
Main service OVER 600V
100 AMP OR LESS
Main service EA. ADD'L 100 AMP
Ex. OCCUDIOUTLETS OR FIXTURE
Ex. Occup • ( FIXED APPLNS. OR
OUTLETS (RESID.) EA
Temporary service
Mobile Home Facilities
Misc. Wiring
Permit Fee
MECHANICAL
PERMIT FILING FEE
Heatina
Cooling
Ventilation
$3.00
1.50
1.50
1.50
1.50
1.50
.30
5.00
2.00
$3.00
5.00
2.50
25.00
1.00
50ea
2.00
10.00
15.00
6.25
$3.00
FEE
FEE
Hood 1 1 2.00
Permit Fee $ $
Land Development Fee $
TOTAL PERMIT FEE $
This permit is hereby issued under the applicable provisions of
the Butte County Code and/or resolutions to do work indicated
above for which fees have been paid.
CTO OF PUBLIC WORKS
By 02Date
dui -permit ex ares Date 2�b
COUNTY OF BUTTE DrPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965
Telephone: 534-4541
APPLICATION AND PERMIT
authorize r sentatives of the County of Butte to enter upon the
above -me io ed property for inspection purposes.
is �- d-7—` O//7/7J� Date o
Si natur/e of Permitee or Agent
Receipt No.
White-D.P.W. - Yellow -Assessor - Pink -Inspector - Goldenrod -Applicant
This permit is hereby issued under the applicable provisions of
the Butte County Code and/or resolutions to do work indicated
above for which fees have been paid.
DIAE-c-ro.910F PUBLIC WORKS
By Date
_Bv44�ermit expires Date _ `
BUILDING
Owner
SQ. FT. OCC. BUILDING VALUATION
Mailing Address
S Z�
Telephone No.
Contractor C '
Mailing Address
Fireplace
Total Valuation
r) none
Z
Tele h No.
3 - 73
Permit Fee
Building Address �
Plan Checking Fee&/or Penalty
Permit Fee
PLUMBING No.1 @ FEE
PERMIT FILING FEE $3.00
Each TraD 1.50
Repair drainage or vent piping 1.50
A. P. No. 7 J D
7�- �0��
Zoning &Planning
Water piping 1.50
Each gas water heater or vent 1.50
F/sl
W.
Sanitation
Fire Dept.
Fire Zone
Use Permit
Gas piping system 1 - 5 outlets 1_.50
EQA
Parking
Plans
Parcel
Declaration
Parcel Map
60' R/W I Improvements
Each additional outlet .30
Building sewer 5.00
B
Parcel Approval
Plans Approval
Lawn sprinkler system 2.00
NEW ADDITION ❑ UTILITIES ❑ OTHER
permit Fee $
$
ELECTRICAL No. @ FEE
PERMIT FILING FEE $3.00
600V OR LESS 5.00
Main service 100 AMP OR LESS
Single Family Duplex ❑ Mobil Home ❑ Others ❑
Main service EA. ADD'L too AMP 2.50
V
Main service OVER 600 25.00
100 AMP OR LESS
Main service EA. ADD•L 100 AMP 1.00
NEW OR ADDNST % ACC. BLDGS.LING CCUP. S+\ 20Sq}t
//
CONTRACTORS LICENSE LAW
I am licensed under the provisions of Chapter 9, Div. 3, of the
State of California Business & Professions Code under the name
St e Qf��- �/i�►/'/A
L �� � ( c/
NEW CONSTR. MULTI-OUTL T
NON -REBID BRANCH CIRCUITS) 2.50ea
NEW CONSTR. (POWER APPARATUS 8
NON•RESID. SINGLE OUTLET CIR.
Ex. OCCUD(OUTLETS OR FIXTIiRES I BAL@1
FIXED APPLNS. OR
EX. QCCUp. � OUTLETS (RESI D.) EA) 2•00
Temporary service 10.00
ZS� cJ� �,` � d %), (;5 9z�
Mobile Home Facilities 15.00
C!
License No. ysl%% Classification
Misc. Wiring 6.25
❑ I am exempt from the Contractors License Laws of the State of California.
Permit Fee $
$
MECHANICAL No @ FEE
WORKMEN'S COMPENSATION INSURANCE
I am aware of the provisions of Section3700 of the California Labor
Cod which requires every employer to be insured against liability
G orkmen's Compensation.
I have placed on file with the County of Butte a certificate of
Workmen's Compensation Insurance.
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 Workmen's Compensation Laws of
California.
PERMIT FILING FEE $3.00 3 66
Heating DO M add r C)C�
Cooling T , DO
Ventilation
Hood 2.00 �D
Permit Fee $
$
I certify that I have read this application and state that the above
information is correct. I agree to comply to all County Ordinances
and State Laws relating to building construction, and hereby
Land Development Fee
$
TOTAL PERMIT FEE$
authorize r sentatives of the County of Butte to enter upon the
above -me io ed property for inspection purposes.
is �- d-7—` O//7/7J� Date o
Si natur/e of Permitee or Agent
Receipt No.
White-D.P.W. - Yellow -Assessor - Pink -Inspector - Goldenrod -Applicant
This permit is hereby issued under the applicable provisions of
the Butte County Code and/or resolutions to do work indicated
above for which fees have been paid.
DIAE-c-ro.910F PUBLIC WORKS
By Date
_Bv44�ermit expires Date _ `
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
' 7 County Center Drive — Oroville, California 95965
Telephone: 534-4541
APPLICATION AND PERMIT
BUILDING '
Owner SQ. FT. OCC. BUILDING VALUATION
Mai I i ng Address
Telephone No.
Contractor
Mailing Address `3CI Qr /Tj,;P 11&Je4
Building Address
ITelephone No.
i
A. P. No. — — / JQ r`n Zoning & Planning
Fees W SauiAa+on Fire Dept. Fire Zone Use Permit
EQA I ParkingI Declaration p p Parcel
Plans Parcel Ma 60' R/W I Improvements
I I Plans Approval
NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER
Single Family V Duplex ❑ Mobil Home ❑ Others ❑
CONTRACTORS LICENSE LAW
I am licensed under the provisions of Chapter 9, Div. 3, of the
State of California Business & Professions Code under the name
style of:
License No. ��3S��Sr Classification C b
Fireplace
Total Valuation
Permit Fee
Plan Checki ng Fee &/or Penalty
Permit Fee
PLUMBING
PERMIT FILING FEE
Each Trap
Repair drainage or vent piping
Water piping
Each gas water heater or vent
Gas piping system 1 - 5 outlets
Each additional outlet
Building sewer
Lawn sprinkler system
Permit Fee
ELECTRICAL
PERMIT FILING FEE
main service 6001 OR LESS
100 AMP OR LESS
Main service EA. ADD'L 100 AMP
Main service OVER 600V
100 AMP OR LESS
Main service EA. ADD'L 100 AMP
NEW CONST. / DWQIRCICM fr7 CUP. 'Y
$3.00
1.50
1.50
1.50
1.50-
1.50
30
5.00
2.00
$3.00
5.00
2.50
25.00
1.00
FEE
FEE
Ex. OCCUO(OUTLETS OR FIXTIIRES
OCI
BAL@IFIXED
APLNS
EX. Occup.(OUTLETS P(RESID )REA)
2.00
Temporary service
10.00
Mobile Home Facilities
15.00
Misc. Wiring
6.25
❑ I am exempt from the Contractors License Laws of the State of Cal ifomia. Permit Fee
MECHANICAL
WORKMEN'S COMPENSATION INSURANCE
PERMIT FILING FEE
I am aware of the provisions of Section3700 of the California Labor Heating
Code which requires every employer to be insured against liability
for Wo en's Compensation.
have placed on file with the County of Butte a certificate of
Workmen's Compensation Insurance.
❑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 Workmen's Compensation Laws of
California.
I certify that I have read this application and state that the above
information is correct. I agree to comply to all County Ordinances
and State Laws relating to building construction, and hereby
authorize rePres
ntatives of the County of Butte to enter upon the
above-mentione property for in ectio purposes.
X Date 8J 7B
Signature of P i or t
Receipt No.
White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant.
Cooling
$3.00
ME
Ventilation
Hood 1 1 2.00
Permit Fee $ $
Land Development Fee $
TOTAL PERMIT FEE $' W-0
This permit is hereby issued under the applicable provisions of
the Butte County Code and/or resolutions to do work indicated
above f r which fees have been paid.
Do ECT F PU 911LIC WORKS
B e Date
"r
Building permit expires Date77'
IZ %
COUNTY OF BUTTE — DE�PAR'TMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95965
Telephone: 534-4541
APPLICATION AND PERMIT �C
\JSignoture of Permitee or Ag t Date l
l �U
�O/� �
�
yl
Receipt No. -
White-D.P.W. - Yellow -Assessor - Pink -Inspector - Goldenrod -Applicant Building permit expires Date7 /�L �% 9
BUILDING
Owner
SO. FT. OCC. BUILDING VALUATION
Mailing Address
Telephone No.
g S
Contractor f
Mai I i ng Address
Fireplace $cry
Total Valuation
Telephone No.
Permit Fee S
Building Address 3�Q '^
Plan Checking Fee Vor Penalty
Permit Fee
-�
PLUMBING No.1 @ FEE
PERMIT FILING FEE $3.00
Each TraD 1.50
�� ¢
L u re --P-
Repair drainage or vent piping 1.50
A. P. No. — r-�,
_
oning & Planning
Water piping 1.50
Each gas water heater or vent 1.50
F es
W.
-Sen+iaiiea
FireDept.
FireZone
Use Permit
Gas piping system 1 - 5 outlets 1.50
EQA
Parking
Plans
Parcel
Declaration
Parcel Map
60' R/W
Improvements
Each additional outlet .30
Building sewer 5.00
ec
Parcel Approval I
Plans Approval
Lawn sprinkler system 2.00
NEW ❑ ADDITION ❑ UTILITIES ❑ OTHER
Permit Fee $
$
t� y -
c,,Q
ELECTRICAL No. @ FEE
PERMIT FILING FEE $3.00
Main service 600V OR LESS
100 AMP OR LESS 5•��
Single Family-],JDuplex ❑ Mobil Home ❑ Others ❑
Main service EA. ADD'L 100 AMP 2.50
Main service OVER e O 25.00
100 AMP OR LESS
Main service EA. ADD'L 100 AMP 1.00
NEW CONS. /DWELING OR ADDNST % ACCLBLDGS.CCUP. 51 20sq ft
CONTRACTORS LICENSE LAW
I am licensed under the provisions of Chapter 9, Div. 3, of the
State of California Business & Professions Code under the name
style of:
NEW CONSTR MULTI .OUTL T
NON.RESID BRANCH CIRCUITS 2.50ea
NEW CON STR (POWER APPARATUS 9
NON.RESID. SINGLE OUTLET CIR.
Ex. OCCUD(OUTLETS OR FIXTURES 50j
FIXED APPLNS. OR
Ex. Occup. OUTLETS (RESID.) EA) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Licens No. Classification
Misc. Wiring 6.25
am exempt from the Contractors License Laws of the State of California.
Permit Fee $
$
MECHANICAL No. @ FEE
WORKMEN'S COMPENSATION INSURANCE
1 am aware of the provisions of Section3700 of the California Labor
Code which requires every employer to be insured against liability
for Workmen's Compensation.
❑I have placed on file with the County of Butte a certificate of
Wor en's Compensation Insurance.
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 Workmen's Compensation Laws of
California.
PERMIT FILING FEE $3.00
Heating
Cooling
Ventilation
Hood 2.00
Permit Fee $
$
I certify that I have read this application and state that the above
information is correct. I agree to comply to all County Ordinances
and S aws relating to building construction, and hereby
autho ze rep entatives of the C ty of Butte to enter upon the
abov -m d prop rty f ins ctio oses.
Date
Land Development Fee
$
TOTAL PERMIT FEE
$ e
This permit is hereby issued under the applicable provisions of
County Code and/or resolutions to do work indicated
fo which fee, have been paid.
?��
R TOR OF PUBLIC WORKS z /
\JSignoture of Permitee or Ag t Date l
l �U
�O/� �
�
yl
Receipt No. -
White-D.P.W. - Yellow -Assessor - Pink -Inspector - Goldenrod -Applicant Building permit expires Date7 /�L �% 9
For -, Urgent ❑
Date ;,71Z150,.a Time vim« .3
W i le You Were Out
Of
Phone
AREA CODE NUMBER SIGN
Telephoned QPlease Calle]
Came To See You ❑ iCalfs
Retur gd Your Call ❑ Wants To. See You.❑
it
Message c ?,IA I.
Signed
9 1
1 ADAMS BUSINESS FORMS