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Home My WebLink About026-030-007026-030-007 PERMIT#96-2739 U'REN, Cary / 6685 Irwin Ave., Palermo Cont: What Cheer Company E 1 e Ser Ch/SF FI G 3-4 98 4 026-.030-007 «' PERMIT#96-2739 ~' U'REN, Gary t 6685 Irwin Ave., Palermo ...., Cont: What Cheer Company Ele Ser Ch/SF ' 4 j F f T OFFICE COPY Address ,-GAS :Date Meter By ELECTRIC Da . Meted By mer" j f �J ri COUNTY'OF BUTTE -DEPARTMENT Or'IDltVELOPMENT SERVICES -BUILDING DIVISION 7 County Center Drive - Oroville, Californya 95965 - Telephone (916) 538-7541 PERMIT NO. APPLICATION AND PERMIT 9� ASSESSOR PARCEL NUMBER W 2.5 BUILDING PERMIT OWNER GAW Ulm, TELEPHONE SQ. FT. OCC. BUILDING VALUATION OWNERS MAILING ADDRESSf�8J%0 A' . /�yY�' U ryr�ry-.! 7.7-JLJ\J CONTRACTOR'S NAME tw ��111\1,►1►J�i.1.Lf:+� T 53 CONTRACTORS MAILIN•a ADORss� �, A �l 9590 lJ1 Fireplace p CONSTRUCTION ENOM UNKNOWN Total Valuation $ Fling Fee $ 20.00 LENDERS MAILING ADCRESS Permit Fee $ ARCHITECT OR ENGINE_ER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEERS MAILING ADDRESS Penalty $ BUILDING ADDRESS 66E6 IM PERMITFEE $ PLUMBINGPERMIT Filing Fee 20.00 Plij1M Each Trap 7.00 LOT NO. SUBDIVISION'S NAME PARCEL MAP Solar Or heat pump water heater 23.00 Water piping 15.00 USEOFSTRUCTURE SF ❑X Duplex ❑ Mobilehome ❑ Other SPECIFY Each gas water heater or vent 15.00 Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilites ❑ Installation ❑ Other (3 -- Describe Work: 2^rr {it�j('i, Mobile Home IS I GI W @20.00 PERMITFEE s Contractor ELECTRICAL PERMIT Filing Fee 20.00 Main Service000V OR ESS /�T� ( 200A OR ESS ) 23.00 M• Main Service ( 200A TO 1000A ) 46.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury 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. License Class C 1 d Lic. No. l U s l OWNER -BUILDER DECLARATION I hereby affirrn under penalty of perjury that I am exempt from the Contractors License Law for the fc1lowing reason: ❑ I, as ow ier 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. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason NEW CONST. DWELLING OCCUP. SO. OR ADDNS. ( s ACC. BLDS. ) 3.50 FT. NEW CONST.MULTI-OUTLET NON-RESID. ( BRANCH CIRCUITS ) 97.50 WER (aPs NG E OUTLETTCIR. ) Ex. Occup. (ourET OR FIXTURES) BAL Q ,:50 FIXED APPWS. OR EX. Occup. (OUTLETS (RESID.) EA ) 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 23•%b P& CCN 123.00 PERMITFEE $ 89.OD Contractor WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 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. ❑ 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier MECHANICAL PERMIT Filing Fee 20.00 9 Heating Cooling Hood 6.50 Ventilation PERMITFEE $ Contractor Policy Number (The above sections need not be completed if the permit is for work of a valuation /Of one hundred dollars ($100) or less.) .0�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 workers' compensation laws of California, and agree that if I should become subject to the workers' -compensation provisions of; section 3700 of the Labor Code, I shall forthwith comply with those �rovisions/ . _1 e Date ' = v Signature c'f Applicant - ❑ Owner/0 Contractor ❑ Agent An OSHA permit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height. Mobile Home Installation Fee is Energy Inspection Fee Is OCC CONST. TYPE TOTAL FEE $ 89.00 HA2. I D. FEES IMP FLOOD F PARCEL CDPD HD ISSUE _V/ This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do work indicated above for wrich fees have been paid. .(��'-� tlG?L, By Date PERMITEXPIRESON 12 1G/9*7 (Date) Receipt No. 209451 WHITE-D.D.S -B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT 11 Ll COUNTY OF BUTTE- DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION 7 County Center Drive - Oroville, California 95965 - Telephone (916) 538-7541 PERMIT NO. APPLICATION AND PERMIT �fr' ASSESSOR PARCEL NUMBER 026--030-007Z4, 2.5 BUILDING PERMIT OWNER GARY Ulm TELEPHONE SQ. FT. OCC. BUILDING VALUATION OWNERS MAILING ADDRESS (%85 imoN Act, OMV=, 95� 7 VM CONTRACTOR'S NAME WMT QRZ AWV1�VYJ.LL1i TEtWU53 CONTRACTORS MAILING ADDRf37 P=ALE AVE OROV=, 95%6 Fireplace CONSTRUCTION LENDER UNKNOWN Total Valuation $ Filing Fee $ 20.00 LENDER'S MAIUNG ADDRESS Permit Fee $ ARCHITECT OR ENGINEER LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ ARCHITECT OR ENGINEER'S MAILING ADDRESS Penalty $ BUILDINGADDRESS 6685 D4JIN PERMITFEE $ PLUMBING PERMIT Fling Fee 20.00 PALOW Each Trap 7.00 LOT NO. SUBDIVISIONS NAME PARCEL MAP Solar Or heat pump water heater 23.00 Water piping 15.00 USEOFSTRUCTURE SF ❑X Duplex ❑ Mobilehome ❑ Other SPECIFY Each gas water heater or vent 15.00 Gas piping system 1 - 5 outlets 15.00 Building sewer 15.00 TYPE OF WORK New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation ❑ Other Describe Work: EEB6 SE}i�KE Mobile Home I S I GI W 1 920.00 PERMITFEE ; Contractor ELECTRICAL PERMIT Filina Fee 20M00 Main Service ( OOOV200A OR LESS OR LESS ) 23.00 23.00 Main Service ( 200A TO 1000A ) 46.00 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury 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. / / D / License Class G 6 D Lic. No. t ` L OWNER -BUILDER DECLARATION 1 hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: ❑ 1, 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. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ 1 am exempt under Sec. Business and Professions Code for this reason NEW CONST. DWELLING OCCUP. OR ( 8 ACC. BLDS. ) SO. 3.5Q FT. CNS. NEW CONST. MULTI.OUTLEr NON•RESID. ( BRANCH CIRCUITS ) 97.50 (a 9OINGLE OUTLET CIA. ) Ex. Occup. (OUTLET OR FD(TURES) BZL 0 I:50 Ex. Occup. (GFIXEEDrs PES D.OR 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 23.00 RE INCT =,ON 23.00 PERMITFEE $ 89.00 Contractor WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 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. ❑ 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier MECHANICAL PERMIT Filing Fee 20.00 9 Heating Cooling Hood 6.50 Ventilation PERMITFEE $ Contractor Policy Number (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) 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 workers' compensation laws of California, and agree that if I should become subject to the workers' compensation ovisions of ction 3700 of the Labor Code, I shall forthwith comply with ose rovisio Y �1 Date �� '�l� / _ gnature of Applicant - ❑Owner ❑ Contractor ❑ Agent An OSHA permit is required for exc ations over 60" deep and demolition or construction of structures over 3 stories in hei I. Mobile Home Installation Fee $ Energy Inspection Fee $ OCC CONST. TYPE TOTAL FEE $ 89.00 HAZ. D. FEES IMP FLOOD COF PARCEL PO HO ISSUE' This permit is hereby issued under the of the utte County Code and/or indi to above r wrich fees have /Q, B �W� y PERMITEXPIRESON applicable provisions Resolutions to do work been paid. Dat �B l (O �q (Date) Receipt No. 209451 WHITE-D.D.S.-B.D. CANARY -ASSESSOR PINK -INSPECTOR GOLDENROD -APPLICANT ;_`. w•.w+ .4r'� ::Pc� ,� ..-+r-� , rwoc7 ': �4*,-+v. v'.st+NT i.. .. _. '/ COUNTYOF BUTTE - DEPARTMENTOF DEVELOPMENTSERVICES -BUILDING DIVISION 7COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA95965 -TELEPHONE (916) 538-7541 l PERMIT APPLICATION DATA SHEET Q� ` ' ` OWNER n 1 / _ _ A & P. No. !��-d� 7 Proposed Building Use 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 BY 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12: 13. 14. 15. 16. 17. 18. 19. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. All items have been submitted . ............. .......................... Plot plans, 3/4 sets, signed by prF'rer of plans . ........................... Complete plans, 3/4 sets, signedTby preparer of plans. . Engineered plans and calcs, 3/4ysets, with wet signature on plans . ............. Hazardous Material Form. ... ........................................ Energy Design Compliance and supporting documentation . .................. Statement of Intent for Non -Heated and A/C Buildings . ..................... . Engineered truss details and layout in duplicate (required prior to plan check). ... . Mobilehome data and manufacturer's installation instructions, 2 sets. ........... Fees of $ ............ .......................... . Impact fees as shown 6n attached schedule . .............................. California Department of Forestry plan approval/fees. ....................... . Flood elevation letter (100 year flood) by California Engineer . ................. . Sanitation and plot plan approval Health Department . ............. City of Chico plumbing permit ..... . Plot`plan and business license approval from City of Biggs/Gridley. .............. Planning approval for (A) Use: (B) Parking: . ......... Contact Land Development.about (A) Improvements (B) Drainage. .......... . Driveway permit [const r c ' approval requiredP rior to occu anc ) P y iPfe4npecton reque- toBuPre-inspection for required. .. ng Inspector (Date) Contractor's license information. (No., Name Style, Classification) . .............. Certificate of.Workmans Compensation Insurance . .......................... Owner Builder Verification (Given to owner , Mail to owner . .......... . Recordedpy_of Agricultural Acknowledgement Statement . .................. Letter of signature authorization . ........................................ Copy of recorded deed of parcel creation and 60 right of way to a public road. .... . Letter of intent on building use . ............................................ Mobilehome utility clearance . ..................................... Documentation of legal access . ..................... :................. . Documentation of 50% subdivision developed or (A) Road improvements completed and (B) Parcel meets zoning area and frontage requirements . ............... Existing violations/expired permits . ...................................... Plan check list . ..................................................... When you issue the errr� , process as follows: M�.i to_`own Mail to c ✓ Telephone �5 �'W�nd hold for pickup at Ut/U� t office Other Parcel Creation i Acreage App'cant Copy of Haz-Mat form sent Health Dept. Fire Dept. Air Pollution D; 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: with inspector. Date � ✓ S By Contractor, designer, owner, was advised of above required data by _ phone _ mail Counter by _ Date Contractor, designer, owner, was advised of above required data by _ phone _ mail Counter by _ Date ;Plans checked by Date Plans approved by Date Sets of plans on hold in File cabinet AP folder Copy - Department of Public Works COUNTY OF BUTTE- DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING DIVISION 7 County Center Drive - Oroville; California 95965 - Telephone (916) 538-7541 APPI MATION AND PERMIT PERMIT NO. ASSESSOR PARCEL NUMBER ZoIS BUILDING PERMIT OWNER TElEPI-IONE So. Fr, OCC. BUILDING VALUATION OW MARJNO ADD S CO M RS TESERLONE r. `� CO TORS DRESS Fireplace CONSTRUCTION LENDER UN OWN Total Valuation $ Fling Fee $ 20.00 LENDER'S MAIUNG ADDRESS - - - - Permit Fee $ ARCHITECT OR ENGINEER - LICENSE NO. Plan Checking Fee $ Energy Plan Checking Fee $ - ARCWTECT OR ENGINEERS MAILING ADDRESS - ' Penalty $ eulLDwoADOREss - PERMITFEE S LUMBING PERMIT Fling Fee 20.00 p 7.00 LOTNo. SUBONSIONSNAME PARCEheat JEa pump water heater 23.00 iping 15.00 USEOFSTRUCTURE SF kDuplex O Mobilehome O Other SPECIFYsewer s water heater or vent 15.00 ng system 1 - 5 outlets 15.00 15.00 TYPE OF WORK New ❑ Addition O Remodel ❑ Utilities O Installation O Other Describe Work: 0�ELECTRICAL ome S G W @20.00 PERMITFEE $ Contractor PERMIT Filino Fee 20.00 -` Main Service ( 11.00.1OR LESS0J 2ooA OR LESS / 23.00 3 I Main Service ( 200A TO I000A ) NEW CONST. DWELLING UP. OR ADONS. ( d ACC. eLnS. ) 46.00 SO. 3.50 FT. ' LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm under penalty of perjury 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. License Class Lic. No. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: ❑ 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._ ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. O 1 am exempt under Sec. Business and Professions Code for this reason NEW CONST. MULTI.OUTLET NON RESIo. (� ANc PARATUS ) @7.50 WER ( a SINGLE OUTLET CIA. Ex. Occup. (OUTLET OR FXTURES ) 20 BAL O '•50 L .SO EX. Occup.FI%ED APPLNS. OR (OUTLETS )RESID.) EA) 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 �93-,C�o 3 -La PERMITFEE S — Contractor 92. MECHANICAL PERMIT Filing Fee 20.00 WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: O 1 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. ❑ 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier Policy Number (The above sections need not be completed if the permit is for work of a valuation of one hundred dollars ($100) or less.) ❑ 1 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 workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, I shall forthwith comply with those provisions. X _______ Date Signature of Applicant - ❑ Owner O Contractor O Agent An OSHA permit is required for excavations over 60" deep and demolition or construction of structures over 3 stories in height. Heating Cooling Hood 6.50 Ventilation PERMITFEE $ Contractor Mobile Home Installation Fee Is Energy Inspection Fee $ OCC CONST. TYPE TOTAL FEE $ T HqZ, D. FEES I IMP I FLOOD coF PARCEL Po HD ISSUE This permit is hereby issued under of the Butte County Code end/or indicated above for which fees have By PERMITEXPIRESON me applicable provisions Resolutions to do work been. paid. Date )Date) Receipt No. r� I I1 e o n r...Qy.A- SFSSOR PINK -INSPECTOR GOLDENROD -APPLICANT COUNTY OF BUTTE BUILDING DIVISION_, DEPARTMENT OF DEVELOPMENT SERVICES 1469 Humboldt Road, Chico, CA - (916) 891-2751 7 County Center Drive, Oroville, CA - (916) 538-7541 747 Elliott Road, Paradise, CA - (916) 872-6307 CORRECTION NOTICE A routine inspection indicates that the following violations of Butte County Ordinances exist at the above address and should be corrected. Please notify this office when correction of work .' is completed. If you have any questions pertaining to this matter, or need additional explanation, please contact this office immediately. - r Date — Inspector 1/ REV 10/ 2 r �.r v Date — Inspector 1/ REV 10/ 2 LOCATION: CONTRACTOR: pRE-INSPECTION FOR PERMrr HISTORY: TYPE OF OCCUPANCY: DATE TO INSPECTOR I IAS FOLLOWS: BUILDING INSFc ACTOR' S REPORT ing Description: [ ] Commercial/Usage: [ ] ResidentiaU# of Units: Mobile Home: Yes[ ] No[ ] [ ] Currently Occupied. [ ] Abandoned/Vacant. ric: Yes [ ] No Electric is currently :[K'On [ J Off Condition of electrical? . Natural[ ] Propanea None[ J Currently OnY ] Off[ ] Obvious problems: anitation: Plumbing working Yes[ ] No[ ] Well: Yes[ ] No[ ] Potable water: Yes[ ] No[ ] Obvious Sewage Problems: ion Recommended:. [ Vs1sue [ ]Hold for: Date: COUNTY OF BUTTE- DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION r1 7 County Center Drive - Oroville, California 95965 Telephone (916) ,53&7541 ' PERMIT NO. APPLICATION AND PERMIT' ASSEssORPARMNUMM n � /D: " _ D `007,/ _ m _ . !• :�' BUILDING PERMIT TEu�►bNE :SO. FT. OCC. • BUILDING VALUATION„ ADO �'� ..` • �' �' - TFLEP►IDl1E j - t. j• l .-- Cy.. CO Rs ..t: N -A a ORE88 FireplaceS- u" " eo UDWIM ,. _ Total Valuation s Filing Fee $" << ;20.00 LSD MS MMJW AWRIMS_Permit Fee .. $ ECT AacHrroaENDo+EEA I UCENSENo Plan Checking Fee Energy Plan Checking Fee $ ARCWMCT OR @IONEIERS MAUNO ADCRE88 - Penalty BUUxwAooaEsa , l' r r .,PERMITFEE PLUMBING PERMIT Filing Fee 2`20.00 PARCEL ""PSolar tOT ND. • SLIaON61ON9 NAM! _ Each Trap 1 or heat pump water heater '7.00. r s 23.00 . Water piping :.15.00 ,Az - USEOFSTRUCTURE Each gas water heater or vent - 15.00 '- Gas piping system 1 - 5 outlets 15.00 SF Duplex ❑ Mobilehome O Other SPECIFY Building sewer15.00' TYPE OF WORK Mobile Home S G W @20.00 New O Addition O Remodel O Ubtites O Installation ❑ Other PERMITFEE _ Contractor Describe Work: ELECTRICAL PERMIT Filing Fee 120.00 __Z0 . Main Service wov oR LES ,�o„ oR LFss 23.00 3 Main Service ( 200A TO 1000A NEW CONST. DWEl1JNo OCCUP. OR ADONS. ( a ACC. BLDs. 46.00 SO. 3.5d FT. ' LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code. my license is in full force and effect NEW CONST. MULTI.OUTLET ` NON-RESID. ( BRANCH CIRCUITS / c?7.50 POW APPARATUS ( a SINGLE OUTLET C10. Ex. Occup. (OUTLET OR FOrTURES , 20 ®1 SAL 0 ASO and License Class I Lic. No. OWNER -BUILDER DECLARATION 1 hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason: ❑ 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. O I, as owner of the property, am exclusively contracting with licensed contractors to construct the project ❑ 1 am exempt under Sec. Business and Professions Code for this Ex. Occup.(FIXEDAPPL"S. OR ouTLETs (RESID.1 EA 5.00 Temporary Service 23.00 Mobile Home Facilities 20'00 Misc. Wiring 73- 23.00 .� PERMITFEE $ — Contractor Q,LID MECHANICAL PERMIT Fling Fee 20.00 reason WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: O 1 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. O 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Heating Cooling Hood 6.50 Ventilation PERMITFEE $ Contractor Carrier Mobile Home Installation Fee Is Policy Number (rhe above sections need not be completed if the permit is for work of a valuation O 1 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 workers'HAL of one hundred dollars ($100) or less.)FT�his compensation laws of California, and agree that If I should become subject to the workers' compensation provisions of section 3700 of the Labor Code, 1 shall forthwith comply with those provisions. Energy Inspection Fee Is CONST. TYPE TOTAL FEE $ 0. FEES IMP FLOOD COF PARCEL PO HD ISSU rmit ishereby issued under me applicable provisions ote Butte County Code and/or Resolutions•to 'do* work X _____ Date __— Signature of Applicant - O Owner O Contractor O Agent An OSHA permit Is required for excavations over 60" deep and demolition or construction of structures over 3 stories in height. indicated above for which fees have By PERMITEXPIRESON been. paid. Date ReceiptNo.(Dara► PINK -INSPECTOR GOLDENROD•APPLICANT