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HomeMy WebLinkAbout022-350-016'22-35-16 1406-89B,P, ,M CHIP(Manuel &Ana Pineda) 2864 2nd St.,lot 6; City o Biggs ..(new single family.) • 7Y y Y ., f 22 CHIP(Manuel & Ana Pineda) 2864 2nd St.,lot 6, City of Biggs pi (new single family) PI WNWR I CONTR. t ASSESSOR PARCEL LOCATION OFFICE COPY I Addresr�l 0 `/" oo�� fir/'Cn ' / C-4- � GAS Meter By pato ETRIC M By DW Temp. Power Pole Called PG&E Temp. Elec. Service Called PG&E Temp. Gas Sen Called PGA JOB FINALED Signature RECEIVED MAR 3,01990 ENERGY INSTALLATION CERTIFICATE %, '\Building Owner r 110-5 &4%2 %2 Building Permit # •�'~Building Location�1e_61T w DESCRIPTION»JF INSULATION ROOF Material Thickness(inches) EXTERIOR WALL, Material FL Thickness(inche ) CEILING Batt or Blanket Type Thickness(inches) Loose Fill Type (7g:- // a Minimum Thickness(Inches) 8.3 s Area covered(ft.2) /08'0 _ FLOOR, ELEVATED- Material LEVATED-Material Thickness(inches) FLOOR, SLAB Material Thickness(inches) Width(inches) FOUNDATION WALL Material Thickness(inches) Brand Name Thermal Resistance (R.Value) . Brand Name GZIC. Thermal Resistance(R Value) .P-// Brand Name Thermal Resistance(R Value) Brand Name r—fogn" Number of Bags 3 / Wt. per bag .2$' lb. -Thermal Resistance(R Value) .,4e-,30 Brand Name Thermal Resistance(R Value) Brand Name Thermal Resistance(R Value) Brand Name Thermal Resistance(R Value) I hereby certify that the above insulation was installed in the above building, is consistent with approved building department plans and attachments and con- forms with requirements of Chapter 2-53 of State of California -Energy Requirement! 336/-7/ FIRM NAME/OWNER STATE CONTRACTOR'S LICENSE NO. ,61q 3/2 ez �o SIGNATURE OF INSTALLATION APPLICATOR DATE I hereby.certify the required features, devices, and equipment, az� shown on the approved Building Department plans and attachments have been installed and conform to the appli- ance'standards and Chapter 2-53 of the State of California Energy L6quirements. BUILDING CONTRACTOR/OWNER (Please Print) (FIRPi N) S—IGNAT7 OF BUILDING CONTRA TOR/OWNER HVAC FIRM NAME/OWNER (Please Print) STATE CONTRACTOR'S LICENSE NO. DATE STATE CONTRACTOR'S LICENSE NO. SIGNATURE OF HVAC CONTRACTOR/OWNER DATE , THIS CERTIFICATE MUST BE ON FILE WITH THE BUILDING DEPARTMENT PRIOR TO FINAL INSPECTION APPROVAL AND A COPY SHALL BE POSTED WITHIN THE BUILDING. SEPTD-IBI'R 1988 � � � �� � , :fi =OK 0'= Not OK Not Not Ready MOBILE HOMES MISCELLANEOUS Date MOBILE HOME UTILITIES (Plans) OK except #'s Date DECKS,COVERS,CARPORTS,GARAGES, (Plans)OK except #'s 1. Zoning Requirements -Setbacks -Easements, 1. Zoning Requirements -Setbacks -Easements . 2. Soils; Special MH Support -Sketch 2. Footings; Soils -Size -Depth -Spacing -Connectors -Steel 3. Sewer; Location -Test -Fall -C/O -Concrete + 3. Decks; Girders and/or Joists -Decking -Bracing -Stairs -Rails 4. Water; Location -Test -Easement Needed (Sketch) 4. Wood Awn.; Posts-Beams-Rftrs.-Connec.- Shthg.-Rfg.-Bracing ' 5. Electricity; Location-Clearances-Grnd.-/ / Amp -Concrete 6. Gas; Location -Test -Wrap: / PV ft. / . /"Nat. or/ /"L"ft./ P'LPG 5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures 6. Carports; Windows -Doors + 7. Utility Clearance 7. Elec. 8. Frmg; Sills-Anchors-Studs-Rftrs-Trusses *� 9. Siding; Nailing -Veneer -Stucco -Mesh Card -B1 Date Card -131 Date 10. Roof; Shthg-Roofing Card -131 Date Card -B1 Date 11. Ext.; Steps -Doors -Landings - Date MOBILEHOME INSTALLATION (Plans) OK except #'s 1. Zoning Requirements -Setbacks -Easements Card -B1 Date Card -B1 Date 2. Footings; Size -Spacing -Marriage Line Card -81 Date Card -131 Date 3. Gas; MH Test -Demand -Valve -Connector , 4. Electricity; MH Test -Crossovers -Breakers -Clearances Date POOLS (Plans) OK except #'s 5. Drain; MH Test -Fall -Flex Connector 1. Setbacks -Easements 6. Water; MH Test -Regulator -Connector 2..Soils; Compaction -Structure Stability 7. Water and Sewer Connected -C/O to Grade -HD Approval 3. Pool Structure; Steel -Connections -Thickness - Dead Men -Lining 8. Gas and Electricity Tagged a 9. Exits; Insp.-Sketch 4. Elec.; Receptacles and Lighting, Distances-GFI 10. Cert. of Occupancy 5. Elec.; Pool Lighting; 15 volts-GFI 6. Elec.; Enclosures; Conduit Entries -Terminals -Listed 7. Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater 8. Elec.;Grounding; Equip. w/5' -circulating Equip. -Pool Lghtg. Boxes-Enclosures-Panel boards- Ins. to Main in Conduit Card -B1 Date Card -B1 Date Card -131 Date Card -131 Date 9. Health Department Approval ' 10. Plumb.; Cir. Test -Water. Supply Test Card -131 Date Card -131 Date Card -61 Date Card -B1 Date I 0 L = vr< 0 = NotOK RESIDENTIAL (Single and Duplex) - = Not Applicable = Not Ready Date U DE FLOOR (Plans) OK except #'s Date FjAMING (Continued) Hing -Setbacks; -Easements -Flood -Slope 5,.,Hangers-Post Caps -Anchors -Connectors . Ft ., Main; Soils-Steel-Elec. Grnd. ." Ftg. Depth q6. Cing. Joist-Rftr. Ties-Purlin-Roof Brac.-Truss-Shthng.-Rfng. CVFt9,--6arage; Soils -Steel-/ /" Ftg. Depth A Flue -Fireplace, Throat Clearance t,oll-g., Porches & Decks; Soils -Steel-/ /"Ftg. Depth 8. Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles ain; Steel-Blockouts-Wrapped drm. Windows or Exiting Doors -Sill Hgt. & Dimensions emwalls Garage; Steel-Blockouts-Wrapped 15(rGarage Fire Protection Framing Slab; Steel -Wrapped 1.5 -1 -Property Line Firewall & Openings 8-1301 r--PMeptatt Ftg.-Steel 15T . -Ext. Doors -One 3' -Check Garage -3rd story, 2 exits .W.V.; Fall -Fittings -Test -2 way C/O -Sewer Test 5 Rise -Run -Landing -Fire Protection 10. Gas Pipe; Size -Anchors 54. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers 11. Water Pipe; Test -Anchors -Regulator -Service Test . Siding -Nailing Veneer 12 FI trir;! �^ ��•^roundeed-Fd. Vents-Underflr. Access 13 PI nume &,9uets; Clearance- Material -Su pprt-Ins. — 't-57. Glazing Area -Glass Protection -Skylights -Plastic 1 - - nchor Bolts -Joists -Vents -Cripples a - olts 15. histilatoen :Q�_ . nsulation-Vbt -Clg. 60. Infiltration-Walls-Wndws Card -131 Date %br9!Card-B1 Date Card -131 Date7-1)4Z*Card-B1 Date Date PL MBING (Permit) OK except #'s Water Ht. Vent -Access -Combustion Air -Baffle 17 ater Pi e; Test & Anchors -Nail Protection W.W.V. T st- ttngs & Anchors -Nail Protection First Floor -Tub Access er, 2nd Floor -Tub Access I I 1. Gas Pipe; Size & Anchors Card -B1 CICD, DateQ-1- Card -B1 Date Card -61 Data -b Card -B1 Date Card -Bt Dat Card -81 Date kly Date PJWAL (Plans) OK except #'s 1. xt. Steps -Door & Sidelight Protection -Landings 2. Sgmake Detector Furnace; Vents -Clearance -Comb. Air -Connector - r -Ducts -Meeh. Protection "edroom Exiting P"65, .F.I. & Bath Fixtures & Tub Access -Spa Elec. Trim &-6vbpanet, Breaker Sizes -Labels Card -131 Date and -131 Date 6Clearances-Hearth Panel; Int. & Ext. Date ECTRICAL (Permit) OK except #'s f Fixt. & Appliance; Grnd. -Air Gap -Cooking Clearance 22. fixture & Transformer Clearance -Ins. Protection 1. Elec. Outlets &Receptacles at Kit. Counter . Elec. Receptacles Spacing -Lights &Switches at Doors ge �r or; Swing -Landing -Closer L.24. Size Boxes & No. of Conductors -Stapled Duct in amper ,Romex Installed Close to Edge of Studs & C.J. 4. Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.- r -Meeh. Protection 6. Equip. Ground made up w/Mech. Fasteners -Bond Gas & Water ( . 2 Appliance Circuts in Kitchen & Conductor Size/G.F.I. 5. 5*., Elec. & Mech. Equip. Listed for Location - / ga. Cu or Ai-A.C. Wire Size / /ga. u or Al p€c. Receptacles in Garage; (G.F.I.)-Romex Protec. Lvr Insulation -Foam -Looked in Attic 13 Yes 9. Range Circ. /(j / ga. Cu o van Circ. / / ga. Cu or Al. �sulated Neutral Yes o 7 struction-Post Caps W,SeTrvice-Riser Conductors & Ground -Main Disconnect le Door -Drainage & Wood -Earth Clearance Looked under Floo ❑ Yes 1. Equip. Clearances Panels-Motors-Mech. Equip. 80. Following instld.; Driv e Planters ❑ Yes o s ❑ No; Walks b1fes ❑ No; ht -Shower Light -Spa Light . Smoke Detector Card -131 Datg'ZCard-131 Date . Unit; Disconnect, Electrical, Plumbing Card -131 Date Card -131 Date . Vents Above Roof; Plbg.-Appliance-Firepl.-Clearance to Openings. NJ Date CHANICAL (Permit) OK except #'s ct, Electrical, Plumbing 4 A.C. Ducts Insulation & Support ,Ex erior Elec. Trim; G.F.I. Receptacle -Underground 5. Vent Fan; Exhaust above insulation 6. V ntilation throughout House D re & Overflow; Size & Gradess Protection rna - a< Access -Comb. Air -Return Air Vent -115 outlet 8. C rections from Previous Inpections 38. ccess & Platform if Furnace in Attics Test -Meters Tagged; Gas -Electric b.y4diter & Sewer Connected -C/O to Grade -HD Approval Energy Compliance Certificate -Other Certificates Card -81 Card -81 Dat and -B1 Date Date Card -B1 Date 92. Roofing Certificate Card -131 Date -and-B1 Date s Card -131 Date Card -131 Date Date FBAMING (Plans) OK except #'s Card -B1 Date Card -B1 Date 9. ills, Proper Material & Anchors Comments at Final: "60. _Walls Studs -Nailing, Spacing & Bracing—Plates-Sound _Bearing Walls over Girders & Floor Nailing ft Stop in Walls (rat proof) ire Stops; Furred Ceilings -Stairs -Chases -Tub 4• Header & Beam -Size & Bearing (NOTE An entry must be made each time you visit iob site) COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS 7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-i APPLICATION AND PERMIT ERMIT 2 — J 5- " Filing Fee 10.00 BUILDING PERMIT .OWNER TELEPHON SQ. FT. OCC. BUILDING VALUATION +'OWNER'SAILIN AD ESS /'� 8 or.� Pa Gro` e 5.00 6. Each qas water heater or vent .CONTRACTOR'STELEPHONE ow NA pE dot -1 e� Gas piping system 1 - 5 outlets 5.00 CONTRACTOR'S MAi G ADDRESS 5.00 ' Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ LENDER'S MAILING ADDRESS c Di -p v •e Filing Fee $ 10.00 Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee i ARCHITECT OR ENGINEER'S MAILING ADDRESS -� Energy Plan Checking Fee $ Penalty $ BUILDING ADDRESS 2 ,* 6 ^ / <)J -. Permit fee $ 1. LOT NO. SUBDIVISIONS NAI -D A `G PARCEL MAP nG.CG USE OF STRUCTURE SFA Duplex❑ Mobilehome❑ Other SPECIFY New)] Addition ❑ Describe work: TYPE OF WORK CONTRACTORS LICENSE LAW I declare under penalty of perjury (check one): ❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business and Professions Code and my license is in full force and effect. License No. Classification I, as the owner, or my employees with wages as their sole compen- sation, will do the work,and the structure is not intended or offered for sale. (Sec. 7044) ❑ I, as the owner, am exclusively contracting with licensed contract- ors.(Sec. 7044) ❑ 1 am exempt under Sec. , Business and Professions Code for this reason WORKMEN'S COMPENSATION INSURANCE I declare under penalty of perjury (check one): �] The permit is for $100.00 (valuation) or less. ❑ I have placed on file with the County of Butte Building Department a Certificate of Workmen's Compensation Insurance or a Certificate of Consent to Self -Insure. I shall not employ any person in any manner so as to become subject to the W. C. laws of California. Notice_ to Applicant: If after making this statement, -should you become subject to the :W. C. provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 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. I also agree to save, indemnify and keep harmless the County of Butte against all liabilities, judgments, costs, and expenses which may in any way accrue against. sai ounty in consequence of he granting of this permit X Date Signat a of Applicant — Owner ❑ Contractor ❑Agent An OSHA permit is required for excavations over 5'0" deep and demolition or construct- ion of structures over 3 stories in height. Receipt No.12 xjlct�/ WNITE-D.P.W., YELLOW-ASa(aaOK. PINK -INSPECTOR. GOLDENROD -APPLICANT PLUMBING PERMIT Filing Fee 10.00 Each Trap 2,00 Solar or heat pump water heater 20.00 Water piping 5.00 6. Each qas water heater or vent 5.00 Gas piping system 1 - 5 outlets 5.00 Building sewer 5.00 ' Mobile Home S I G I W 10.00 ea I Permit Fee $ 14-19 Flll Contractor ELECTRICAL PERMIT Filing Fee 10.00 Main service 600v OR LESS 100 AMP OR LESS 10.00 Main service EA. ADD'L 100 AMP 2.50 NEW CONST. DWELLING OCCUP.y` OR ADONS. ( ACC. BLDGS. / 1 /20sgftNEW ' NON.RESID R. .BRAMULNCH CIRCT ITS 2.50 ea POWER APPARATUS e SINGLE OUTLET CIR. / Ex. OCCUp(OUTLET3 OR FIXTURES e AL0 AL@S 0 3 FIXED APPLNS. OR Ex. Occup. OUTLETS (RESIO.) EA.1 2.00 Temporary service 10.00 Mobile Home Facilities Misc. Wiring 15.00 Permit Fee $ Contractor MECHANICAL PERMIT Filing Fee 10.00 Heating Cooling it�t/& 10,00 Hood r3.00 Venti lation rerrni[ ree Contractor Mobile Home Installation Fee $ Energy Inspection Fee $ TOTAL PE MIT FEE $ O,WUP-1 CONST.T)fPEI ISCmoolerFl.OOD PARCEL PD HD This permit is hereby issued under the applicable provi- sions of the Butte County Code and/or resolutions to do work indicated above for which fees have been paid. DIRECTOR OF PUBLIC WORKS BY Date S- --3 PEWIT EXPIRES Date -' ZJ­flo ,n,-..:. ..;r,r—, wa+. �"".".�,�J"'�+ri'►i ��`-r.ia+f 7 �-•• r''rJ'�7��k. n-�'r�.��$�f •K'r"'t�; �-.it,+�'i�"we'f4^.�{k9�et�`M' +�r+q "v"; r—�. ..,- —wi COUNTY OF BUTTE DEPARTMENT.OF PUBLIC WORKS -BUILDING DIVISI>ON r 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE: 916/538-7541 PERMIT APPLICATION DATA SHEET t Permit No. OWNER P. No. Proposed Building Use a Building Inspector Date t At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance: DATE RECEIVED APPROVED 1. All items have been submitted . .................................... 2. Plot plans in duplicate/triplicate, signed by preparer of plans........ 3. Complete plans in duplicate/triplicate, signed by preparer of plans 4. Complete engineered plans and calcs, with wet signature on plans .. 5. Energy Design Compliance and supporting documentation ......... 6. Statement of Intent for Non -Heated and AC Buildings .............. — 7. Engineered truss details and layout in duplicate (required prior to plan check) 8. Mobilehome installation data including manufacturer's installation instructions....................................................... 9. Fees of $ .......................... 10. Chico Urban Area fees paid ......................................... 11. Parkfe s paid .................................................. 12. School District fees paid ................. _ 13. SanitationIr roval from Health Department ... A All 4. City of Chico plumbing. -permit ...................... . _727,1 Plot plan and business license approval from City of (see City for other requirements) 16. Planning approval for (A) Use: (B) Parking: ........ . 17. Improvements may be required. 18. Driveway permit (construction approval required prior to occupancy) ... 19. Pre -Inspection for required ... • Pre-int° • . Buildinngg Inn. requestspector (Date) 20. Contractor's license information (No., Name Style, Classification) ....... 21. Certificate of Workmans Compensation Insurance .................... 22. Owner -Builder Verification (Given to owner ❑, Mail to owner ❑) ........ 23. Recorded copy of Agricultural Acknowledgment Statement ............ 24. Lettof signature a thorization..................................... . 5. 26. When you issue the permit, process as follows: Mail to owner. Mail to contractor. Telephone and hold for pickup at office. Deliver w/inspector. Other Applicant Date Copy of plans sent Health Dept.,. Fire Dept., Other Date The following data must be submitted prior to permit issuance: (Circle new item not checked above). 1. Index permit for above items No. 2. Additional items required: % Contractor, designer, owner, was advised of above required data by_phone---nail—counter by date Contractor, designer, owner, was advised of above required data by—phone —mal l—counter by date Plans checked by ���—Date �Plans approved by Date Sets of plans on hold in File cabinet AP folder Copy—DPW 4 COUNTY OF BUTTE - 7eparCuient of Public Works 7 County Center Drive, Oroville,. CA 95965 Phone: 916-538-7541 OWNER -BUILDER VERIFICATION Attention Property Owner: An "owner -builder" building permit has been applied for in your name and bearing your signature. Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement (yes or no) YES 2. I (have/have not) t.►Trr, signed an application for a building permit for.the proposed work. 3. I olan to provide portions of this vurk but af3encv I have contracted with the following po san- (9-i"4 to provide +4e—p-,a�pe&e-d_ construction technical assistance to coordinate and suri-vise the major work. Name Co rnunifv Housing niiE2royement Pmorani Address 429 Normal Ave City Chico, CP. Phone 891-6931 Contractors License No. 390764 4. I plan to provide portions of this work, but I have hired the following person to coordinate, supervise, and provide the major work: Name N/A Address City Phone Contractors Licensc No. 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: Name Address Phone Type of Work Buttacavoli Industr. lo15 Yuba Str., Yuba City CA 741-2619 Insulation Caldwell Ent., P.Q. Box 787, Cxidlev, CA, 95948 84.6-4142 .Lnets & Coun-er o_c Coleman Concrete Constr., 91 Lone Tree Rd. Oroville, CA 534-3303 Cumberland Plumbing,40 Oak -,rale Ct., Oroville 534-0589 uiq Foothill Electric, •5887 Orrin Lane Paradise, CA 877-1357 E ec ica Fox CO., 3995 Olive Hca. Oroville, CA, 533-27 0 ea inq Trojan Truss Co. P.O. Box 85, Orland, CA, 95963, 865-232 0o russes Signed: Rakae l Property Owner Social Security Date 7P1/1,1t_P4 NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and 19832 of the California Health and Safety Code. This verification must be completed and returned to our office before we are mitted to issue the permit. per_ When recorded mail to: Chico Housing Improvement 429 Normal Avenue Chico, CA 95928 ATTOR14EY-IN-FACT AGREEMENT I/We hereby appoint the Community Housing Improvement Program and/or any of its authorized agents as my/our attorney-in-fact for the purpose of executing any notices of completion, waivers of liens and/or stop notices and/or release of liens and/or stop notices and building permits relating to that certain real property described as follows: All that certain land situate, lying and being in the County of Butte , State of California, described as follows: Lot 6 of Pichotta Subdivision , as shown on that certain map filed for record in the office of the county Recorder of the County of Butte , State of California, on January 15 , 1988 , in Book 108 of Maps and Surveys, at page 59 4/21/89 Date Date 121189- STATE OF CALIFORNIA County of Butte OFFICIAL SEAL LINDA F: WILSON NOTARY PUBUC - CALIFORNIA BUTTE COUNTY My Comm. Expires Feb. 15, 1*M Owner Manuel Pineda Owner L. Punz6 Pineda On this 21stday of April in the year 1989 , before me Linda F. Wilson , a Notary Public, State of California, duly commissioned and sworn, personally appeared Manuel Pineda and Ana L. PUnzo Pineda personally known to me or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument, and acknowledged to me that (s)he executed the same. IN WITNESS WHEREOF I have hereunto set my hand and affixed my official seal in the County of Butte on the date set forth above in this certificate. Notary Public State of California Linda F. Wilson My commission expires February 15, 1992 ti/ATEF-- rtc'f EF - o 6 c� Q• PP 10' Pj `} 22 FF.cfI-I- � / SETBAG�- t. Zo WOoc p, � Pp -o PosEo 3 6�,0 e. ('1 RESioEraG� / t-lo�j'E S f .A -f! II/ATE F -I S E CJ 6 �-- �} Go0t-;-:CTra r1 FEES. 2. P k o R-- To 0CC J rA t4c" ( ALA- dTrl-rTiOFS SOT rH(�ovEr'IGrITS H S T C.o M P L-( u0 1 T to 50 t3ory rs�or--I ooc�NE�-+'jS. SITE PLAN LOCATION: . 2Pxo4 2►�o STRL�- -pIC, 40Tt#4 Sj)bo%vrsro r-1 GA AP NO. r 2� A a v t� °on fele buif�i ApO\See Master � Pla: for Oster 5 plons. q+ �0 e-,, ze-u- ;4"07-m, I NOTES: FIA3P� p-dF r-1 Al "F1 EA.0 Gr.IG1 6e P-, PLAN N °•321 f�i . 0 COMMUNITY_ . HO.IJSING -IMPRROVEMENT PROGRAM 428 NORMAL, AVE. CHICO LOT. NO- Co . OWNER N coA DATE: r 9 • SF PT. 1988 SCALE: BUTTE'COUNTY_,SCHOOLS DEVELOPMENT FEE CERTIFICATION FORM (One Form,pq;r 13uilding) A.P. Number 2.2 `j,j %b Building Department No. i School District s. ,City County [::] Jurisdiction Property Owner Pa 9 e / ih e,cc /° // 4 Project Location/Address 8 6 'Zw� �lp Subdivision �� G�dq Lot Number �O I N Residential Development: Sq. Footage 1080 # of Living MHI Addition (Group R) 1- Units. ' :' , ' F , -'�`: k?.t �. •. tr�._;� -. t.r r' y.y �., - r4i�" .,:,{; �, S,� .�c� , � i.,wl.....T,�_. _* . YFootage t g€ `Commercial/Industria•1:� SqFoota e New Addition (Including Exterior r S Roofed Areas) Building Department Representative Date . ^J * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * (Floor Plans reviewed by School District Personnel) District Id No. ��n is School District certifies, , hat (Applicant Name) (Phone Number) (Street Address) " -• (City) (State) - (Zip Code) has complied with the requirements of Resolution No. S` by the payment of $����, �o', representing JOCO square feet. School District Representative Oate PAID BY CHECK NO. �� REMARKS: BANK NO 9Od ?SDS��/� S% , PAID BY CASH ter - white -applicant, yellow -building department, pink -school district SCHOOL.FEE (8/88) .. 0. i• M.. 5 •�