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22-35-4.5 1410-89B,P,E,M 1
;_^• CHIP(Emma Ceballo
2899 2nd St.,lot 35 City of Biggs
(new single family
PERI
I PERMIT EXPIRES
i OWNER
CONTR.
ASSESSOR PARCEL
LOCATION
OFFICE COPY
Addressa 9 9
GAS
Meter By D e
ELIC
Me y 9
Temp. Power Pole
Called PG&E
Temp. Elec. Service
Called PG&E
Temp. Gee Service
Called PG&E
JOB FINALED (Date)
t •
Signature
RECEIV E( 3 01
~heilding Owner
Building Location
ENERGY INSTALLATION CERTIFICATE
Building Permit #
DESCRIPTION'OF•INSULATION''
ROOF
'Material Brand Name 3�•
Thickness(inches) Thermal Resistance-(R,,Value)
EXTERIOR WALL -
Material �L��t Fi'c ��i._�s-QJ Brand Name OC F
Thickness(inches 3.5 Thermal Resistance,(R Value)
CEILING
.Batt or Blanket Type
Thickness(inches
Loose Fill Type �a-d_2
Minimum Thickness(Inches) $..3 "
Area covered(ft.2) R4 `l
FLOOR, ELEVATED
Material
Thickness(inches)
FLOOR, SLAB
Brand Name
'Thermal Resistance(R.Value)
Brand Name Co i2- 0 EX
Number of Bags 25 Wt. per. -bag 29_lb..'
Thermal,Resistance(R Value) R-3 o
Brand Name
Thermal Resistance(R,Value)
Material Brand Name
Thickness(inches) Thermal Resistance(R•Value)•
Width(inches) n.
FOUNDATION, WALL
Material Brand Name
.Thickness(inches) Thermal Resistance(R-Value)
I hereby certify that the above insulation was installed in the above:building, .
s.consistent with.approved building department plans and attachments and con-:.
forms with requirementp of Chapter Z-53 of•State of California Energy Requirement.9
FIRM NAME/OWNER . STATE .CONTRACTOR.'S :LICENSE>.NO...•,
AA Q-c.�C e��e-u- a -L � � , 3/ a 8 /4 6
SIGNATURE OF INSTALLATION APPLICATOR -DATE '.
I hereby certify the required features, devices, and equipment, a5 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 .equirements..
BUILDING CONTRACTOR/OWNER (Please Print) STATE CONTRACTOR'S.LI_CENSE..NO.; .'
(FIRM NAIME)
SIGNATURE OFLDING CONTRACT R/OWNER DATE.
HVAC FIRM NAWOWNER, (Please Print) 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.
SEPTaBER 1988
= OK
I
0=Not OK
Not MOBILE HOMES
_
MISCELLANEOUS
= Readyable
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.
5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures
6. Carports; Windows -Doors
/ /"Nat. or/ /"L"ft./ /"LPG
7. Utility Clearance z
7. Elec.
8. Frmg; Sills-Anchors-Studs-Rftrs-Trusses --
9. Siding; Nailing -Veneer -Stucco -Mesh
Card -131
Date Card -131 Date
10. Roof; Shthg-Roofing
Card -81
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 -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/0 to Grade -HD Approval
3. Pool Structure; Steel -Connections -Thickness -
8. Gas and Electricity Tagged
Dead Men -Lining
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.;Ground ing; Equip. w/5' -circulating Equip. -Pool Lghtg.
Card -B1
Date Card -B1 Date
Boxes-Enclosures-Panelboards-Ins. to Main in Conduit
Card -81
Date Card -61 Date
9. Health Department Approval
10. Plumb.; Cir. Test -Water Supply Test
Card -131
Date Card -131 Date
Card -131
Date Card -B1 Date
=UK
0 = Not OK
- = Not Applicable
= Not Ready
Date UNDfI
RESIDENTIAL.(Single and Duplex)
R (Plans) OK except #'s
,t Q�tg., ; Soils-Steel-Elec. Grnd.-/ P' Ftg. DeptF
tg. arage; Soils -Steel-/ P' Fig. Depth
it 14 g., Porches & Decks; Soils -Steel-/ /"Ftg. Depth
5. Stemwalls, Main; Steel- Bloc kouts-Wrapped
6. Stemwalls, Garage; Steel- Bloc kouts-Wrapped
8. Pi -Fireplace Ftg.-Steel
. D.W.V.; Fall -Fittings -Test -2 way C/O -Sewer Test
10. Gas Pipe; Size -Anchors
11. Water Pipe; Test -Anchors -Regulator -Service Test
12. Electric; Underground
13. Plenums & Ducts; Clearance- Mated al -Su pprt-Ins.
14. Girders -Sills -Anchor Bolts -Joists -Vents -Cripples
15. Insulation
Card -61 Date Card -131 Date
Card -131 Date Card -131 Date
Date PL SING (Permit) OK except #'s
weer -Ht. Vent -Access -Combustion Air -Baffle
AI'Vtafe'r Pipe; Test & Anchors -Nail Protection
1 .W.V.; est ttngs & Anchors -Nail Protection
� Shower an• Test First Floor -Tub Access
er, nd Floor -Tub Access
!fZ . Gas Pipe; Size & Anchors
Card -B Dater _ and -61 Date
Card -B1 Date Card -131 Date
Date"ELECTRICAL (Permit) OK except #'s
22. Ixture & Transformer Clearance -Ins. Protection
3. fec. Receptacles Spacing -Lights & Switches at Doors
4. 5 e• Boxes & No. of Conductors -Stapled
Q . Romex Installed Close to Edge of Studs & C.J.
quip. Ground made up w/Mech. Fasteners -B d Gas & Water
Appliance Circuts in Kitchen & Conductor Size .
ize / / ga. Cu or AI-A.C. Wire Size / /ga.
Cu or Al
29. Range Circ. / / ga. Cu o Al- ven Circ / ga. Cu or Al.
_4isulated Neutral Yes No
0. Service -Riser Conductors & Ground -Main Disconnect
-tt-Equip:`Ctearances Panels-Motors-Mech. Equip.
f2 -t.: athes-Closet Light -Shower Light -Spa Light
�3. Smoke Detector
Card -131 C40 DateA - and -131 Date
Card -131 Date Card -B1 Date
Date MkqHANICAL (Permit) OK except #'s
4. A . Ducts Insulation & Support
Vent Fan; Exhaust above insulation
rain Overflow; Size & Grade
Furnace -Vent; Access -Comb. Air -Return Air Vent -115 outlet
'38 -Attic Atc-dss & Platform if Furnace in Attic
Card -131 Dat - Card -B1 Date
Card -131 Date Card -131 Date
Date FRAMING (Plans) OK except #'s
ills, Proper Material & Anchors
1Nalls Studs -Nailing, Spacing & Bracing -Plates -Sound
Bearing Walls over Girders & Floor Nailing
aft Stop in Walls (rat proof)
e Stops; Furred Ceilings -Stairs -Chases -Tub
Header & Beam -Size & Bearing
Date F"ING (Continued)
S. Hangers -Post Caps -Anchors -Connectors
LW-Clng. Joist-Rftr. Ties-Purlin-Roof Brac.-Truss-Shthng.-Rfng.
4 r Type A Flue -Fireplace Throat Clearance
8. attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
(,44'130rm. Windows or Exiting Doors -Sill Hgt. & Dimensions
LSti��jarage Fire Protection Framing
Property Line Firewall & Openings
jXyj'Ext. Doors -One T -Check Garage -3rd story, 2 exits
droom -Rise- Run- Land ing-Fire Protection
lywood on Roof Overhang -Attic Vents -Rafter Outriggers
iding-Nailing Veneer
66--�Mesh=Brrp Screed -Fd. Vents-Underflr. Access
L6' . Glazing Area -Glass Protection -Skylights -Plastic
s; ai mg= olts
9_q_9Insulation-Walls-Clg.
60. Infiltration-Walls-Wndws
Card -131 Dat - Card -131 Date
Card -131 Date 11 Card -131 Date
Date FI L (Plans) OK except #'s
1. [�crSteps-Door & Sidelight Protection -Landings
S e Detector
fiB'Turnace; Vents -Clearance -Comb. Air-Connector-
oor-Ducts-Mech. Protection
4 . 8 droom Exiting
5. G...I. & Bath Fixtures & Tub Access -Spa
Elec. Trim & Subpanel; Breaker Sizes -Labels
68. F4 learances-Hearth
Panel; Int. & Ext.
Ki Fixt. & Appliance; Grnd. -Air Gap -Cooking Clearance
u , c. Outlets & Receptacles at Kit. Counter
PT'Garage Fire Door; Swing -Landing -Closer
- amper
74. Wtr. Htr.; Vents -Clearance -Comb. Air-Connector-P.R.V.-
Protection
tlf5. P ., Elec. & Mech. Equip. Listed for Location
6. Elec. Receptacles in Garage; (G.F.I.)-Romex Protec.
i," -Foam -Looked in Attic ❑ Yes
Beek Construction -Post Caps
awl Hole Door -Drainage & Wood -Earth
Clearance Looked under Flo ❑ Yes
80. Following instld.; QriyV es ❑ No; Walks &Ves ❑ No;
Planters ❑ Yes la''No
8i.
C. Unit; Disconnect, Electrical, Plumbing
Vents Above Roof; Plbg.-Appliance-Firepl.-Clearance to
Openings.
8 . ct, Electrical, Plumbing
5. Exterior Elec. Trim; G.F.I. Receptacle -Underground
6. Ventilation throughout House
Glass Protection
orrections from Previous Inpections
P11-9.,Gas Test -Meters Tagged; Gas -Electric
6. ater & Sewer Connected -C/O to Grade -HD Approval
1�1i. Energy Compliance Certificate -Other Certificates
92. Roofing Certificate
i
Card-B1Date[. 2nrd-131 Date
Card -B1 Date Card -131 Date
Card -131 Date Card -131 Date
Comments at Final:
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC
7 County Center Drive - Oroville, California 95965 - Telephone:
APPLICATION AND PERMIT
WORKSPERMIT N
916/538-754
ASSESSOR PARCEL NUMBER
2 —
ZONING
BUILDING PERMIT
OWNER�E)yu¢O/
TELEPHONE
S0. FT. 0 C. BUILDING VALUATION
OWNER'S MAILING ADDRESS � a
i/�-
CONTRA TOR'S NAME1.6
! [/
TELEPHONE
CONTRACTOR'S MAIL G ADDRESS
Fireplace
CONSTRUCTION LENDER
UNKNOWN
Total Valuation $
Filing Fee
$ 10.00
LENDER'S MAILING ADDRESS /
0_0 v t `i a
Permit Fee
$
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee
$ 16
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
� � ,
Permit fee
$
PLUMBING PERMIT
Filing Fee 10.00
tL124
Each Trap61
2,00
Solar or heat pump water heater
20.00
LOT NO.
7J
SUBDIVISION NAME
t ` C'
PAR EL M P
i f!
V
Water piping
5.00
Each qas water heater or vent
5.00
USE OF STRUCTURE
SFA Duplex❑ Mobilehome❑ Other
SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
5.00
Mobile Home S I G I W
0.00 ea
TYPE OF WORK
NeWA Addition ❑ Re 1 ❑ Uti litiies ❑ Ilat' Other ❑
Describe work: t G V
TOL/ p $e C V. -c le ole
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service eOOV OR LESS
100 AMP OR LESS
10.00
V V0
Maln service EA. ADD'L 100 AMP
1 2.50
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)
❑ 1, as the owner, am exclusively contracting with licensed contra
ors. (Sec. 7044)
❑ I am exempt under Sec. , Business and Professions Code
for this reason
NEW CONST. DWELLING OCCUP.a ,
Z
OR ADDNS. ACC. BLDGS. �¢sq it
NEW CONSTR U TI.OUT LET
NON-RESID .BRANCH CIRC ITS 2.50 ea
POWER APPARATUS &)
(SINGLE OUTLET CIR.
Ex. Occup�OUTLET3 OR FIXTURES 2ALO 30
ele
FIXED APP LNS. OR
EX. OCCUp. OUTLETS (RESID.) EAJ 2.00
Temporary service < 10.0 moo
Mobile Home Facilities 15.00ct-
Misc. Wiring
g 15.00
Permit Fee $ 9r I
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
❑ 1 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.
Contractor
MECHANICAL PERMIT
Filing Fee 1 10.00
Heating
Coolin 9
00
,
Hood
3,00
Ventilation
permit 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.
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 County in consequenc of the granting of this permit.
X Date S1�pnhv
Signa re of Applicant — wner ElContractor ElAgentwork
An OSHA permit is required for excavations over 5'0" deep and d molition or construct-
ion of structures over stones In height.
Mobile Home Installation Fee $
Energy Inspection Fee $
TOTAL -PE MIT FEE
E.1
co sT.r Pc
school F D
PARCEL
V PD
,r
ND Issu
This permit is hereby issued under
sions of the Butte County Code and/or
indicated above for which
BY 2!DIRECTOR 0 PUBLIC
PEP.4 EXPIRES Date
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Date y j'�'
{�� ai,%_ 0
Receipt No.
WHITC-D.P.W., YELLOW-ASSCSSON, PINK -INSPECTOR. GOLDENROD -APPLICANT
}
e -At
COUNTY OF BUTTE - DEPARTMEN F_ PUBLIC WORKS - BUILDING DIVISION
7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE: 916/538-7541 f
PERMIT APPLICATION DATA SHEET
;, y Permit No.
Proposed Building Use
At time of permit application, I was advised the following data must be submitted priorto 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 p
12. School District fees paid .................
13. Sanitation TppAal Trom Health Department ...
:ZvCity of Chico plumbing permit ...................... .`.............
iPlot 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 -Ins ection for re ulred .... , Pre-Insperequest to
p q 'Building inspector --mat e)
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 authorization ......................... ........... .
25.Qw
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 submittedrior to ermit 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---mail., counter by _ dated
Contractor, designer, owner, was advised of above required data by—phone —mal l—counter bye date
Plans checked by Date J`'PI'ans approved by Date
Sets of plans on hold in File cabinet AP folder
t;
Copy—DPW
COUNTY OF BUTTE - Department 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) rtAtrr signed an application for a building permit
for the proposed work.
3. I plan to provide portions of this cork but
a�encv
I have contracted with the following R-3- to provide
construction technical technical assistance to coordinate and suxrvise the major work.
Name CQ=ini ty Housing rnm,rnyPm_Pn+- 2rQprani
Address 429 Normal Ave_ City Chico, Cis.
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 Address Phone Type of Work
Buttacav li Industr. 1015 Yuba Str., Yuba Cites CA 741-2619 Insulation
Caldwell Ent., P.O. Box 787, Gridlev, CA, 95948 846-4142 inets & Coun-e-r oc
Coleman Concrete Constr., 91 Lone Tree Rd. Oroville, CA 534-3303
Cun Berland Plumbinc7;40 Oakvale Ct., Oroville 534-0589 ing
Foothill Electric, 5887 Orrin Lane Paradise, CA 877-1357 Electrical
Fox CO., 3995 Olive Hwy., Oroville, CA, 533-27 0 ea 1nq
Trojan Truss Co. , P.O. Box 85, Orland, CA, 95963, 865 -2321 -Dot trusses
Signed: �ma,a Ceda`laS
Property.�Owwner
Date
Social fir
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 rer.urned 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 35 of Pidmtta Sfidivisicn , 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 , 1968 , in Book 10B of Maps
and Surveys, at page 59
April 14, 1989
DateWer- Rm A. Odm les
Date _
STATE OF CALIFORNIA
County of BME
OFFICIAL SEAL
LINDA F: WILSON
• NOTARY PUBLIC - CALIFORNIA
BUTTE COUNTY
My Comm Expires Feb. 15, 1992
L3
Owner
On this 14th day of April in the year
1,989 , before me
Linda F. Wilson , a Notary
Public, State of California, duly commissioned
and sworn, personally appeared..Fhmia A. Ceballos*
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
My commission expires 2/15/1992 .
u
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SITE PLAN P-5
PLAN N°• 4x49
!LOCATION:
!.2899. 2No sTFeE'j'
p, c� O o tfi A S t16 D�-
�IC,GS GA. _
-lAP NO-
i
NOTES: COMMUNITY HOUSII
.IMPROVEMENT PROD'
®���� 488 NORMAL AVE. Cl
I 4 LOT NO. 3 S
OWNER :e
DATE: m •seri', I9 88
SCALE: I" - Z o'
ar ;
BUTTE COUNTY SCHOOLS DEVELOPMENT FEE CERTIFICATION FORM
°
#1 (One Form per Building)
A.P. Number 22 3S'— Building Department No.
School „District S CityL --;-i
unty V L& Jurisdict'on
//dProperty Owner y, e
Project Location/Address
Subdivision y1'
Lot Number
J 3S
_Residential Development:
Sq. Footage
# of Living MHI Addition (Group R)
Units
i
Commercial/Industrial: D Sq. Footage
New Addition (Including Exterior
Roofed Areas)
Building Department Representative_`;`=J. Date
r
(.Floor Plans reviewed by School District Personnel)
District Id No. Q�M
School District certifies that
kY
(Applicant Name) '._., (Pho.ne Number)
R
(Street Address)
(City) (State) . (Zip Code)
has complied with the requirements of Resolution No. `
by the payment sof $1 7-7/ representing'. square feet.
e .S
School,Dil§trict, Representative Oate
PAID BY CHECK NO.
BANK NO
PAID BY CASH
REMARKS:
white -applicant, yellow -building department; pink -school district
SCHOOL.FEE (8/88)