HomeMy WebLinkAbout022-350-02922-35-29 J1409-9B,P,E,M
CHIP(Jo`se & Sandy Alva.r
2891 3nd St.,lot 19,,City of Biggs
(new single family),
;CHIP(Jose & Sandy Alvarez)
+2891 3nd St.,lot 19, City of Biggs
;(new single family)
PI
PERMIT EXPIRES
OWNER
CONTR.
ASSESSOR PARCEL
LOCATION
1 OFFICE COPY
Address
GAS V
Meter By Dat
Temp. Pow EL,ERIC q--�
Called Punt- -- -- ---
Temp. Elea. Service
Called PG&E
Temp. Gas Service
Called PG&E
JOB FINALED (Date)
Signature
R E eEr t L' MAR 3 01990 ENERGY INSTALLATION CERTIFICATE
< l gilding Owner 09/,0- .uild�ng Permit #
Building Location
DESCRIPTION OF INSULATION
ROOF
Material
Thickness(inches)
EXTERIOR WALL
Material
Thickness(inches 3•s -
CEILING
Brand Name
Thermal Resistance (R Value)
Brand Name_()r-F_
Thermal Resistance(R Value) -/
Batt or Blanket Type Brand Name
Thickness(inches) Thermal Resistance(R Value)
Loose Fill Type Brand Name . 'Q2 Dt�-iC
Minimum Thickness (Inches)- 9.3 " Number of Bags 5a Wt. per bag AO lb.
Area covered(ft.2) 1c) Thermal Resistance(R Value) W -3p
FLOOR, ELEVATED
Material
Thickness(inches)
Brand Name
Thermal Resistance(R Value)
FLOOR, SLAB
Material Brand Name
Thickness(inches) Thermal Resistance(R Value)
Width(inches)
FOUNDATION WALL
Material
Thickness(inches)
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 -
for with requirements of Chapter 2-53 of State of California Energy Requirements.
33517/ 1
FIRM NAME/OWNER STATE CONTRACTOR'S LICENSE N0.
a
SIGNATURE OF INSTALLATION APPLICATOR
I hereby certify the required features, devices, and equipment, a5 shown
Building Department plans and attachments have been installed and conform
ance standards and Chapter 2-53 of the State of California Energy .equire.
BUILDING CONTRACTOR/OWNER (Please Print)
(FIRM NAME
SIGNATURE OF BUILDING CONLRACTOR/OWNER
HVAC FIRM NAM /OWNER (Please Print)
(J — /vim'
STATECONTRACTOR'S LI
0
DATE
the approved
the appli-
ts.
02
ATE 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.
SEPTEMBER 1988
= 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/0 -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: / /" L" ft.
/ /"Nat. or/ /"L"ft./ /"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 -B1 Date
10. Roof; Shthg-Roofing
Card -131
Date Card -131 Date
11. Ext.; Steps -Doors -Landings
Date
MOBILEHOME INSTALLATION (Plans) OK except #'s
'
1. Zoning Requirements -Setbacks -Easements
Card -61
Date Card -131 Date
2. Footings; Size -Spacing -Marriage Line
Card -B1
Date Card -B1 Date
3. Gas; MH Test- Deinand-Valve-Con necto r
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/0 to Grade -HD Approval
3. Pool Structure; Steel -Connections -Thickness- ,
Dead Men -Lining
8. Gas and Electricity Tagged
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-Panelboards-Ins. to Main in Conduit
Card -B1 Date Card -B1 Date
Card -81
Date Card -B1 Date
9. Health Department Approval
16
10. Plumb.; Cir. Test -Water Supply Test
Card -B1
Date Card -B1 Date
Card -131
Date Card -61 Date
,
= UK
0 = NotOK
RESIDENTIAL (Single and Duplex)
=Not Applicable
= Not Ready
Date
UNDERFLOOR (Plans) OK except #'s
Date
FRAMING (Continued)
Hing -Setbacks; -Easements -Flood -Slope
5. Hangers -Post Caps -Anchors -Connectors
FUr, Main; Soils-Steel-Elec. Gr /" Ftg. Depth.
Cing. Joist-Rftr. Ties-Purlin-Roof Brac.-Truss-Shthng.-Rfng.
. tg., Garage; Soils -Steel-/ P' Ftg. DepthType
A Flue -Fireplace Throat Clearance
_
f._E , Porches & Decks; Soils -Steel-/ /"Ftg. Depth
48.,Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
Steel- Bloc kouts-Wrapped
9. Bdrm. Windows or Exiting Doors -Sill Hgt. & Dimensions
rage; Steel- Blockouts-Wrapped
L511. Ga age Fire Protection Framing
Slab; Steel -Wrapped
- teel
L&<Noperty Line Firewall & Openings
. Ext. Doors -One 3' -Check Garage -3rd story, 2 exits
. D.W.V.; Fall -Fittings -Test -2 way C/O -Sewer Test
i- droom-Rise-Run-Landing-Fire Protection
10. Gas Pipe; Size -Anchors
K4. Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
11. Water Pipe; Test -Anchors -Regulator -Service Test
. Siding -Nailing Veneer
1j,.fileetrto•- ixlerg round
Drip Screed -Fd. Vents-Underflr. Access
learance- Mate rial-Supprt-Ins.
7. Glazing Area -Glass Protection -Skylights -Plastic
- - c or Bolts -Joists -Vents -Cripples
ling- Bolts
p . Insulation-Walls-Clg.
60. Infiltration-Walls-Wndws
Card-BiQV
Dat i Card -B1 Date
Card -B1
Date -/ rd -B1 Date
Card -B1
Datdk--6 Card -B1 Date
TN 1 11
Card -B1
Date Card -B1 'Date
Date
kUV6lNG (Perm' -OX except #'s
ater Ht. Vent- ccess-Combustion Air -Baffle
Date
#JNAL (Plans) OK except #'s
1 Pipe Test & Anchors -Nail Protection
Pti. t. Steps -Door & Sidelight Protection -Landings
W.V.; es ttngs & Anchors -Nail Protection
2 oke Detector
. Shower Pan; Test, First Floor -Tub Access
63. Furnace; Vents -Clearance -Comb. Air -Connector -
Ip—Garage; Above Floor-Ducts-Mech. Protection
20. Test Tub & Shower, 2nd Floor -Tub Access
21. Gas Pipe; Size & Anchors
._Bedroom Exiting
5. I. & Bath Fixtures & Tub Access -Spa
leg6. Elec. Trim & Subpanel; Breaker Sizes -Labels
Card -B1
Dated Card -B1 Date
Card -B1
Date Card -B1 Date
nces-Hearth
a Woo Panel; Int. &Ext.
Date
ELECTRICAL (Permit) OK except #'s
0. it. Fixt. & Appliance; Grnd. -Air Gap -Cooking Clearance
22. Fixture &Transformer Clearance -Ins. Protection
1. Elec. Outlets &Receptacles at Kit. Counter
�Z. Elec. Receptacles Spacing -Lights &Switches at Doors
z2-@ars ire oor; Swing -Landing -Closer
24. Size Boxes & No. of Conductors -Stapled
7 c in arage-Damper
(� . Romex Installed Close to Edge of Studs & C.J.
4. Wtr. Htr.; Ve - ce-Comb. Air-Connector-P.R.V.-
age; Above Floor-Mech. Protection
Flip. Ground made up w/Mech. Fasteners -Bond Gas &Water
2 Appliance Circuts in Kitchen & Conductor Size/G.F.I.
., Elec. & Mech. Equip. Listed for Location
2fi Ri,bf - ri Wire ize / / ga. Cu or Al-A.C. Wire Size / /ga.
,.-,Cu or Al
W6,&9. Receptacles in Garage; (G.F.I.)-Romex Protec.
�. Insulation -Foam -Looked in Attic ❑Yes
29. Range Circ. / / ga. Cu or AI -Oven Circ. / / ga. Cu or Al.
yvsulated Neutral Yes No
7 ruction -Post Caps
. S ice -Riser Conductors & Ground -Main Disconnect
r oor-Drainage & Wood -Earth
Clearance Looked under Floor ❑ Yes
Equip. Clearances Panels-Motors-Mech. Equip.
80. Following instld.; Drive s ❑ No; Walks es 13No;
Planters ❑Yes ELNer—
s ose ower Light -Spa Light
—
v33. Smoke Detector
Card -B1
Data () Card -B1 Date
Unit; Disconnect, Electrical, Plumbing
Card -B1
Date Card -B1 Date
3. Vents Above Roof; Plbg.-Appliance-Firepl.-Clearance to
Openings.
Date
MECHANICAL (Permit) OK except #'s
Electrical, Plumbing
ft. A.C. Ducts Insulation & Support
9;;9'5,,Exterior Elec. Trim; G.F.I. Receptacle -Underground
35. Vent Fan; Exhaust above insulation
. Vgjatilation throughout House
Condensate Dain & Oy2�low; Size & Grade
ss Protection
37. Furnace-Ve ; Acc s -Comb. ir-Return AiKent-115 outlet
8. Corrections from Previous Inpections
s & Platform if Furnace in Attic
s Test -Meters Tagged; Gas -Electric
0. er & Sewer Connected -C/O to Grade -HD Approval
1. Energy Compliance Certificate -Other Certificates
Card -B1
Card -B1
Dat Card -B1 Date
Date Card -B1 Date
92. Roofing Certificate
Card -B1
Dated and -B1 Date
Card -BI
-IJ Date Card -B1 Date
Date
F13AMING (Plans) OK except #'s
Card -B1
Date Card -B1 Date
9 IIs, Proper Material & Anchors
Comments at Final:
A. IbWls Studs -Nailing, Spacing & Bracing—Plates-Sound
.,Searing Walls over Girders & Floor Nailing
ft Stop in Walls (rat proof)
,Fire Stops; Furred Ceilings -Stairs -Chases -Tub
&,4'4. Header & Beam -Size & Bearing
(NOTE: An entry must be made each time you visit job site)
V
COUNTY OF BUTTE -DEPARTMENT OF PUBLIC
7 County Center Drive - Oroville, Calffomia 95965 - Telephone:
APPLICATION AND PERMIT
WORKSPERMIT
916/538-75;a_
ASSESSOR PARCEN BERZON1NG.
Z —
BUILDING
BUILDING PERMIT
OWNER
lose
TELEPHONE
SQ. FT. OCC. BUILDING VALUATION
OWNER'S MAILING ADD S
P.O. Rex 1, 1C,4
11 Rai
CONTRACTOR'S NAME
LDWh�h mac` P
TELEPHONE
CONTRACTOR'S MAILI G ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation $
LENDER'S MAILING ADDRESS
We
Filing Fee
$ 10.00
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
'%
$ f,
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
Permit fee
$
PLUMBING PERMIT
Filing Fee 10.00
2 eq qZ3h 5'�^
Each Trap
2,00
Solar or heat pump water heater
20.00
LOT NO. SU ISIIOON NAME PARCEL MAP
it?T 1� C� o G.
Water piping
5.00
Each pas water heater or vent
5.00
USE OF STRUCTURE
SF Duplex❑ Mobilehome❑ Other
SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
5.00
Mobile Home S I G I W
0.00ea
TYPE OF WORK
NewEal"Addition❑ Remo ❑ tilities� Inst latio ther ❑
Describe work:
v/he Cm h� ,�
Penult Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service eoov OR LESS
100 AMP OR LESS
10.00
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
1, 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)
❑ I am exempt under Sec. , Business and Professions Code
for this reason
Main service EA. ADD'L 100 AMP
2.50
NEW CONST. DWELLING OCCUP.ei
OR ADDNS. ACC. BLOGS. , /Y0sq ft
NEW CONSTR MULTI -OUTLET
NON-RESIO .BRA CH CIRC ITS 2.50 ea
POWER APPARATUS e
SINGLE OUTLET CIR.
Ex. OCCU OUTLETS OR FIXTURES 20@50t
P eAL990
FIXED AP.PLNS. OR
Ex. Occup. OUTLETS (RESID.) EA.� 1 2.00
Temporary service10.00
Mobile Home Facilities 15.00
Misc. Wiring 15.00
Penult Fee $
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.
No ice to Applicant: If after making this statement, should you becomesubject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shal I be deemed revoked.
Contractor
MECHANICAL PERMIT
Filing Fee 10.00
Heating
Cooling
9
Hood
3.00
Ventilation
Penult Fee
$
Contractor
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.
1 also agree to save, indemnify and keep harmless the County of Butte againstO
all liabilities, judgments, costs, and expenses which may in any way accrue
against sai ounty in consequence of he granting of this permi .
X L�
Date
Signet re of Applicant – Owner ❑ Contractor ❑ AgenKd.
An HA permit is required for excavations over 5'0" deep anolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
TOTAL PER IT FEE
CUP.
CON ST.TY c
IS171
FLOOD
PARCEL
D ND
_
F
—ISSU
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
DIRECTOR F PUBLIC
BY
PE IT EXPIRES Date
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Date t3,�7'}x.41
J �J' 'm
Receipt No.
WHITE-D.P.W.. YELLOW-ASOCSSON, PINK -INSPECTOR. GOLDENROD -APPLICANT
OWNER
. : ` S ,.. _ ... , `vim ./•i , ' , L., .. i t t'. ^'1.�....'v-�",� ... l ..:.+.-...._ ... r . '-'° •'.,.
7 �
COUNTY OF BUTTE - DEPARTMENT OF,UBLIC WORKS - BUILDING DIVISION
7 COUNTY CENTER DRIVE - OROVILLE, dAJFORNU 95965 - TELEPHONE: 916/538-7541
PERMIT APPLICATION DATA SHEET
Permit No.
Proposed Building Use
A. P. No. {
Building Inspector
Date
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. Park fees •aid .....................
12. School District fees paid .................
13.,SanitationyRVr6ZI from Health Department ...
City of Chico plumbing permit .....................:0....
15. 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-Inspec. request to
Building Inspector (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 ............
Letter of signature a thorization ..... �........................... .
25. ...
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 toit iss nce: (Circle new item not checked above),
1. Index permit for above items No. er -
2. Additional items required:
Contractor, designer, owner, was advised of above required data by—phone--Mail � 'counter.b.y'`r date
Contractor, designer, owner, was advised of above required data by—phone _maII—counter by date V
%Plans checked by - Date `� Plans approved by� Date 02 S
Sets of plans on hold in File cabinet AP folder r,r
Copy—DPW
COUNTY OF BUTTE - Department of Public Works
7 County Center Drive, Oroville, CA 95965 Phone: 916-538-7541
UCIVED
OWNER -BUILDER VERIFICATION APR
49$9
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) signed an application for a building permit
for the proposed work.
3. I plan to provide portions of this x%urk but
agency
I have contracted with the following t to provide t#e-y}r�peeecl
construction technical assistance to coordinate and suxi"vise the major work.
Name C aMlni tv HoliGi n.q ThinrnyPrrent- rroarani
Address 429 iornal Ay -P. City Chico, CA
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 License No.
5. I will provide some of the work but I have contracted (hired) the following
persons to provide the work indicated:
Name
Buttacavoli Industr.
Address Phone
lo15 Yuba Str., Yuba Cites CA 741-2619
Type of Work
Insulation
Caldwell Ent., P.O. Box 787,
Gridley, CA, 95948
846-4142
Cabinets & Coun-er c
Coleman Concrete Constr.,
91 Lone Tree Rd. Oroville,
CA 534-3303
Cumberland Plumbina,40 Oakvale Ct., Oroville
534-0589
ing
Foothill Electric, •5887
Orrin laner Paradise, CA
877-1357
Liectrical
Fox CO., 3995 Olive Hvi.,
Oroville, CA,
533-27 0
j7ea inq
Trojan Truss Co. , P.O. Box 85, Orland, CA,
95963, 86
-2321 Rootrusset
Signed: To5e 4UL5 /1lV erre z
Property Owner
Social Security Number .,
Date
NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and
19832 of the California liealtfi and Safety Code.
This verification must be completed and returned to our office before we are per-
mitted to issue the permit.
When recorded mail to:
Chico Housing Improvement
429 Normal Avenue
Chico, CA 95928
ATTORNEY-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 19 of Pichotta Sdxlivision , 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 JaxBry 15 , 1986 , in Book 108 of Maps
and Surveys, at page
~ cl ' ces ci
Date
-89 _
Date
STATE OF CALIFORNIA
County of BUM
OFFICIAL SEAL
LINDA F: WILSON
• NOTARY PUBUC • CALIFORNIA
• BUTTE COUNTY
My Comm. Eapims Feb. 15, 1992
On thisl9th day of April in the year
1989 , before me
Linda F. Wilson , a Notary
Public, State of California, duly commissioned
and sworn, personally appeared .Tose Luis Alvarez
and Sandy Alvarez
personally known to me or proved to me on"t e
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.
No ary Public State of California
My commission expires r.P- Z
I . PAY
atm U'Ti�iTr Lt,.:;Fr
IMPizc '�,,Ip1T� MUST 6:::+ FLY.
Wirt -a
SITE PLAN'
Ds
o' P, u , E, wA
7(A „
;ISI ;�(►� ����'��`'
' 1= F, - 93i
, Gn'
22'
.
-4.0 l' .
I
ale dor bull aing
*Aft 14
-- =
/A9
LOCATION:
NOTES:
.
C,&
AP No.
1N
�POMMIINITY- . OIIBING.
.IMP q�PEMENT GROGRAM
4E9° NORMAL AVE, CHICO
.LOT No• (9'
OWNER
DATE
SCALE::
10,
BUTTE'COUNTY SCHOOLS DEVELOPMENT,,,,FJEE CERTIFICATION FORM
ii (One Form -per' Building)
A.P. Number 3 2_67. Building Department No.
IV- 5"
School Qi`s'tr'k,ct p f' vi c4 5 City [Er—county
Property Owner' 00 e J__ t, ".J /I z 67
At
Jurisdiction
Project Location/Address-2-9 f
Subdivision Lot Number
Residential Development:., � a F-1 Sq. F I ootage
of Living MHI Addition (Group R)
Units
-Sq. Footage
,Commercial/Industrial': F.
New Additibn,(Including Exterior
Roofed Areas)
Building Department Representative:7.W Date
(Floor Plans reviewed by School District Personnel)
Districts Id No.
School District certifies that
(Applicant Name) (Phone Number)
(Street Address),.
`X-
�X
..(City) (State). (Zip Code)
has complied with the requirements of Resolution No.
Eby tll-.e- ayment of i representing- I square feet`.
$tc.h.001 District Representative Date.
A.
/Z
PAID BY CHECK N0. (/ REMARKS:
BANK NO
PAID BY CASH
white -applicant, yellow -building department, pink -school district
SCHOOL.FEE (8/88)
k.