376286, 384939 (SFD)BUILDING PERMIT
PERMIT NO. DEPARTMENT OF BUILDING & SAFETY 7IST
376 2 8 6 COUNTY OF RIVERSIDE FIELD
CONSTRUCTION ESTI „TE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
Zip
�.1"Y3
IST FL.f D V
12ND. FL.
f POR. lk3
SQ. FT. @/ ��
e �fl
UNITS
Valuation
$
SQ. FT. @ YARD SPKLR SYSTEM
Dist.
`
/ �
SQ. FT. @ MOBILEHOME SVC. BAR SINK
F.C.C.
GAR. �kr� SQ. FT. @ ��"
CAR P. SQ. FT. @
WALLSQ. FT. @
SQ. FT. @
ESTIMATED CONSTRUCTION VALUATION $
/ i.
POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL �s
WATER PIPING .vK�
�✓
NOTE: Not to be used as property tax valuation
Use/Case No.
SWIM POOL, PVT
FLOOR DRAIN.
Pl. Ck. Fee $ �,
MECHANICAL FEES
Lot Size
SWIM POOL, COMM
WATER SOFTENER
Construction Fee Dbl $
VENT SYSTEM FAN EVAP. COOL HOOD
. f (,1 S r- - S �
•) •.�
SIGN
WASHER (AUTO)(DISH)
Zone Restrictions
APPLIANCE DRYER
T e
Type
GARBAGE DISPOSAL
Plumbing Fe$
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY !r
Plan No.
'
AIR HANDLING UNIT CFM
Final Dote Inspector
�� 2 ,%
IDLE METER
KITCHEN SINK
Sp. Insp. Fee$
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET it
Supplimental r it Numbers
t• } !
'
COMPRESSOR HP
POLE,TEMP/PERM
LAVATORY
Address City - Zip
HEATING SYSTEM FORCED GRAVITY
Reinsp. Fee
AMPERES SERV ENT
SHOWER--'
Owner/Agent
BOILER B.T.U.
SQ. FT. @ c
BATH TUB
Total Fees
$�.
JTZAddress
SQ. FT. @ c
WATER HEATER
Zip
M.O. N.C. Cash Check
Received by4 t
Trees require
SQ. FT. RESID @1'/.c
SEWAGE DISPOSAL
Address
City Zip
SQ. FT. GAR @ 'i c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL.
60 TOTAL FE.V
MOB. HM. FEE
MICRO FEE MECH. FEE
PL. K�
CONST. FEE ELECT. FEE
SMI FEE
FEE PLUMB. FEE
PERMIT NO.
7 6 2 8 6
Job Address
�.�-y-.��,j--- f - � 1, �- .
Space
Zip
�.1"Y3
Owner
�a y
Community
r
�� • u 1.4/7 �
Valuation
$
Date
94,6— 7 �y
Dist.
`
/ �
Off.
F.C.C.
1AH.Permit Fee $
Micro Film Fee
Cop $
Use of Permit
�4. Pim �f C- C �
_
bw � � ��� ! •�/
Parcel `No.
7 T M� ``dd ��
J
Use/Case No.
Ck. By
Mech. Fee Dbl $
Pl. Ck. Fee $ �,
Set Backs
Lot Size
�%
Construction Fee Dbl $
Legal Description F
�
��•
�
�•'' Z,;,.,
J U C,.� Z•• `•�'�
. f (,1 S r- - S �
•) •.�
R
Electrical Fee Dbl $
Zone Restrictions
Grou P
T e
Type
SMI FeejE
Plumbing Fe$
Bond Amt.
E
Plan No.
'
Plan lie er
Final Dote Inspector
�� 2 ,%
Unt
Sp. Insp. Fee$
Demol. Fee$
Const. Lender Branch
Supplimental r it Numbers
t• } !
'
Regisir. Fee$
Mileage Fee $
Address City - Zip
Witness Fee $
Reinsp. Fee
$
Owner/Agent
Tel.
cr�j
Zip
Total Fees
$�.
JTZAddress
I�Es ,rr� �� r_ s
C9 fro for •� ��
City
6.. r•7 l.�` ! rt/ I d��
Tel. LicenseN
-
Zip
M.O. N.C. Cash Check
Received by4 t
Trees require
Sewage System
Address
City Zip
T LL P
,Sewer District
Form 284-208 (Rev.8/78) @s
L_ _ Jc_ _t.._. -_ r-__— .a_ _- _ .. `__ .
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF WORK verified by:
FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE WITH
THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA.
I HEREBY. CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN
ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE OF CALIFORNIA.
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums 8 Ducts
2A
Slab Grade
35
Furnace Comport.
3
Steel
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
39
Appl. Clearance
7
Framing
40
Fire Damper
8
Vents
41
Smoke Detection Device
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P. L.
43
Final
10A
Fireplace T. 0. C]
OP'N
NO.
ADDITIONAL INFORMATION
— — — - - — —
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
_15 _ Ground Plumb - —
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25
Final
Tank Pit L.Line
REAR OF PROPERTY LINE
P/L P/,
ELECTRICAL APPROVALS
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME
nunuEnv reKmIt �.
PERMIT NO., DEPARTMENT OF BUILDING & SAFETY /// FIELD DST
384939 RB, 0384-934 I.
COUNTY OF RIVERSIDE
' PERMIT NO.
1-384939.1
CONSTRUCTION
ESTIMATE
Zip
�2� �SJOBOYD
wner
NO. ELECTRICAL FEES
NO.
PLUMBING FEES,, .
IST FL.
2ND. FL.
POR-
GAR.SQ.
CAR P.
WALL
ESTIMATED. CONSTRUCTION
1E�,�=� $
SQ. FT. @
Diist.q
UNITS '•
/ y./F CSC.
MH.Permit Fee $. -
Micro Film Fee
t.
SQ. FT. @ YARD SPKLR SYSTEM
Use of Permit
t,� �r 7 A� /� j� �r
9i ��i�Le ttY Lt-�i.••.4�1. -
• .• • i - • -
'qq�]
SQ. FT. @ x.• kl 3 R...r,e o0 MOBILEHOME SVC. � BAR SINK
r j
FT. @ U' `Jf's3 POWER OUTLET ROOF DRAINS
Mech. Fee Dbl 8'.
SQ. FT. @ �^ DRAINAGE PIPING
•t. ,. ,; Set acks t
SQ. FT ..@ DRINKING FOUNTAIN
SQ. FT: @ ., URINAL
}?
4
VALUATION $ {` 27166,50 1 WATER PIPING
250
NOTE: Not to be used as property tax valuation
Zone Restrictions
j.
Group ;Type
SWIM POOL, PVT
,
SMNI'Fee $ 1 '�
FLOOR DRAIN
Dbl $
'
MECHANICAL FEES
y!!•PI
Plan Noo..373
A',� 3 rry3
a Necker /
SWIM,POOL, COMM
Unit
_
WATER SOFTENER
r
VENT SYSTEM
1 FAN EVAP. COOL 1 HOOD
Const. Lender .'Branch
_ i-•�.,,,,,,�
�jSuppiplliimental Permit Numbl
dlDP3$-$,.,`939
-
SIGN
Registr. Fee $
WASHER (AUTO)(DISH)Q
5130.
APPLIANCE
DRYER
1 -
300
Owner Agent -� 'i�I
MiGHABIA BtRUNDT
Tel. - 1
1
GARBAGE DISPOSAL
25
FURNACE
UNIT WALL FLOOR ,' SUSPENDED
4 h.
Address y y� (� �t T �� /p.
BOX. 584' IA QUI.1N AA. -
City r MOT
PALM �I;r.t O1
Zip
LAUNDRY TRAY
Received G
Trees regmred
AIR `HANDLING UNIT CFM
..
a
IDLE METER,
License#
1
KITCHEN SINK
}
A6SORRTION SYSTEM B.T.U.
Address . 2.1 ,
`
TEMP.USE PERMIT SVC
WATER CLOSET
COMPRESSOR} HP
POLE,TEMP/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT'
SHOWER
BOILER
B.T.U.
7SQ. FT. @,' •c.
2-
BATH TUB ".
0
SQ. FT. @ c
_1,
.WATER HEATER
(�
21W
1;3aelL SO. FT. RESID @I'/.t
SEWAGE DISPOSAL
a 01
:.b _ _
: it SQ. FT. GAR @;. s/. c .`
•�; SETT,
HOUSE SEWER
GAS.PIPING
PERMIT FEE'!I�j;
PERMIT FEE
- a0',
PERMIT FEE A
400
DBI:.
TOTAL FEES
" MOB.HM.FEE
MICRO FEE.
'
MECH. FEE
PL. CK. FEE
CONST. FEE
,Z1'e�
ELECT. FEE'
SMI FEE
^''
,LG
PLUMB. FE
47' 00
' PERMIT NO.
1-384939.1
-*
Job Address •� Space
^ 4 flg RAMI REZ.. I
Zip
�2� �SJOBOYD
wner
-
t . ,.
Communis ' t . t • +'
pp �}}y �, -az
�ii.-QUI TA - �. ..,
Valuotion ryry •� r ffqq
$ 2F1C3
`
Date `y� rg ry
Diist.q
'Off.
/ y./F CSC.
MH.Permit Fee $. -
Micro Film Fee
Cop $
Use of Permit
t,� �r 7 A� /� j� �r
9i ��i�Le ttY Lt-�i.••.4�1. -
• .• • i - • -
Parcel.No,
YP 2JU1 f"'J.�
Use/Case No.
Ck. By
Mech. Fee Dbl 8'.
PI. Ck.-Fee $
•t. ,. ,; Set acks t
Lot Size i
+ yy�y 00.91 �}
� ��! � 1. KJtV ( �,5'l�
Construction Fee Dbl $ 1
Legal Description
9 P • _ • .�. • � u -
0 Bye. 3.. S C V L:A` Q #
_ti _r.•- • _ L7
i �` D^
��� KJ���rj-1 •�,'���' i1i L�, `�
Electrical Fee Dbl $ 2 2
Zone Restrictions
j.
Group ;Type
,
SMNI'Fee $ 1 '�
Plumbing • Fee
Dbl $
A700
Bond Amt.
$
y!!•PI
Plan Noo..373
A',� 3 rry3
a Necker /
_
Fincl Date Inspe for
Unit
_
$p. Insp. Fee $
Dental. Fee
$
Const. Lender .'Branch
_ i-•�.,,,,,,�
�jSuppiplliimental Permit Numbl
dlDP3$-$,.,`939
-
Registr. Fee $
Mileage Fee $
Address, //�� Z+p
if I. rj"i is 1� ,.t_<r. ' .L. L.t, A••
Witness Fee $
Reinsp. Fee -
$
Owner Agent -� 'i�I
MiGHABIA BtRUNDT
Tel. - 1
Zip
Tdtal Fees
Is
4 h.
Address y y� (� �t T �� /p.
BOX. 584' IA QUI.1N AA. -
City r MOT
PALM �I;r.t O1
Zip
M.O. N.C.. Cash Chec
Received G
Trees regmred
..
Contractor .. .. -
Tel.. -
License#
sewage System -
Address . 2.1 ,
City Zip
-
PZ THIS PERMIT -SHALL BECOME VOID IF WORK IS NOT.COMMENCED WITHIN 120 DAYS. CESSATION OF WORK
Sewer Dis FOR 120 DAYS 'SHALL'ALSO CAUSE PERMIT TO BECOME VOID.
• I HEREBY AGREE.THAT ALL, WORK IN+ONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE WITH
r �' sv ' • .\ THE LAWS OF RIVERSIDE COUNTY ANINHE STATE OF CALIFORNIA.
22 i
- I HEREBY CERTIFY THAI THEINDIVIDUF�wWHO`�'Rr'ARED THE PLANS AND SPECIFICATIONS HAS DONE SO IN
ACCORDANCEWITH SECTION 5541 OF TAE:BUSINESS AND PROFESSIONS CODE OF THE STATE -OF CALIFORNIA.
Form 28 -208 (Rev.8/78) @s.. .
r
verified by:
2A
Slab Grade
!}s
35
Furnac=e Comport.
3
Steel
36
Inlets 8 Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
--I----
;,1/10y,
39
Appl. Clearance
7
framing
_ 7
40
Fire Damper
8
Vents
41
Smoke Detection Device
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace
P. L.
43
Final _
10A
Fireplace
T. 0. 0
FI ADDITIONAL 114FORMATION
11-/3 CATNr CE. .A 5,d
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall — 20 i-'�✓%��jT
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B Ceiling (Batts) /S
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 _ Ground Plumb
16 Water Piping
17 Rough Plumb V
18 Vents
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25
Final
'
Tank Pit L. Line
REAR OF PROPERTY LINE
P/L $ : �� �P/
(Q
ELECTRICAL APPROVALS
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding WireO O
29B Bonding
30 Fixtures
31 Service
32 Final ^Z,7—
STREET NAME 15
.-•�.... �.. , r xr� 4•',k. w +,.. yr,p� 4T w :i1;iM �,-'l�a.�g,Y`2 �t�x M. •\.�•� �.airs��R.��r• ���
< � � r rlr i, - %f.:t `,4 ,..r9y ♦ `i �y %t7..
NOTICE: THIS IS NOT A BUILDING PERMIT DISTRICT /f
APPLICATION TO CONSTRUCT Permit No
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF RIVERSIDE
n
284f199 9/74 CANARY=FILE, PINK—APPLICAN'
Owner N Architect Contracto��-
_ �j,
Addres(s_ ' V z C� !
Address Address
1� C �• L115 y', �`�_
City City City_ •
hone
Phone Phone—
I (we) the undersigned, hereby certify and acknowledge that I (we) have read the application and agree that if Curb and Gutter, and
cc
C
us
' Z
Paving, and/or Dedication of right of way is required by the County of Riverside, the Riverside County Department of Building and, Safety
3
shall not make a Final Inspection until said requirements have been met. I am also aware that no work is to be done within the County R/W
O
without an encroachment permit.
NOW, therefore, it is agreed that I (we) will not occupy said property and will not cause said property,to be occd pie3^ur til I -(we) have
complied with all>laws of the 'County of Riverside and the State of California governing said property,?.`.,
DATE/`7SIGNATURE OF OWNER AND/OR AGENT
Approvalby Signature from the Following Departments Listed Below -
Must Be Obtained, Prior to the Issuing of a Construction Permit.
` I SPACE NO.
USE OF STRUCTURE
JOB•ADDRESS FAMILY DUPLEX
Z
,SINGLE
LEGAL DESCRIPTIONOF PROP E�RT-f`{rr APARTMENTS AGRIC. [l
r COMMERCIAL INDUSTRIAL ❑
' f
'^
.COMMUNITY ''f '� ALTERATIONS
Z
NO. OF SUBMITTED PLANS _--_ ' USE OF PERMIT ---
W
AA
CASE NO.
Z
N0. OF PARKING SPACES REQUIRED"lNO: OF BUILDINGS NOW EXISTING --
a :'
--"
ZONE SETBACKS: FRONT r SIDE �'�REAR
J m
GRADING PERMIT REQUIRED? YES N01❑ LOT SIZE
X' .t 'i4JJ
SETBACK ORDINANCE,# _— OF FEET REQUIRED;ONir r' STREET
DATE I - SIGNATURE OF.LAND USE70FFICIAL --
/ff
DEDICATION REQUIRED: YES ❑ NO ❑ NO. OF FEET_— t• r
1
VA
CURB AND GUTTER ,REQUIRED: , YES ❑. NO ❑ ! STREET
l
r W
CAN CURB AND "GUTTER Fj�E�ASIBLY 'BE -INSTALLED? YES ❑ NO ❑
4
HAS AN 'ACCEPTABLEP'PLICATION BEEN MADE FOR ENCROACHMENT PERMITFOR DRIVEWAY AND STREET
CIMPROVEMENT
f„YES-`r❑ r�NO ❑
j
DATE SIGNATURE OF ROAD DEPT. OFFICIAL
r
_
SWIMMING POOLS PUBUC
SEWAGE DISPOSAL v%o ,u.
Q W
W; C
S
FOOD ESTABLISHMENT
WATER POLLUTION' REMARKS
FLOOD CONTROL
W AIR POLLUTION ~
^
_ DIV OF HWY
c YOUR PROPERTY, MAY BE SUBJECT TO
c FLOOD. RIVERSIDE COUNTY,ASSUMES
_
N,0 RESPONSIBILITY,IN EVENT -OF FLOOD...
�
n
284f199 9/74 CANARY=FILE, PINK—APPLICAN'
RIVERSIDE COUNTY DEFARTMEFNT OF BUILDING AND SAFETY
CO$RECTION NOTICE
To: Permit No. 3 1
Address: Date: _Z L/
o OUNO PLUMBING - U.P.C., 1976 DITION
1. Approved plans shall be on job for inspection. (U.B.C. 3021.
2. Toilet facilities shall be on job site. (Calif. Health & Safety Code).
3. Post job card. [U.B.C. 3041 .
4. Replace defective fitting at [309) .
5. Support soil pipe each joint ( ), continuous ( ) (3161.
6• Closet bend to extend minimum floor level. [8051.
7. Off set plumbing out of bearing footing. [3151 .
8. Fill soil pipe with water for testing. [3181 .
9. Stop leaks on line. [3181.
10. Unapproved fittings on lirie. [405 and 3101 .
11. Minimum''/ per foot grade require6on line. [4071.
12 -Gas line not permitted under slab. [1213-b1 .
13. Pipe shall not be installed in a strained position. [5031 [1205).
14.All horizontal vents required to drain to fixture it serves. [5051.
15. Total vent area to be equal to largest required building sewer. (504) .
16. Cleanouts to grade. [4061 . .
FOOTING AND FORM INSPECTION - U.B.C., 1976 EDITION
1. Approved plans shall be on job for inspection. [302).
2. Provide legal lot stakes. [301 and 3041.
3'? -j undation footing to be 12 inches - ' s into undisturbed soil and1� 2 inches - 15
inches wide. [Table 29-A'P.
4• Regrade and compact fill, minimum.thickness of concrete floor, 3Y: inches. [26231 .
5. Fireplace footing to be 12 inches larger each dimension than fireplace. [3707(b)1 .
6• Interior bearing footings to be 12 inches into undisturbed soil; width, minimum 12 inches.
(2907 (b)1 .
7• Pier footings minimum 16 inches square. [Chapt. 291 .
8. Forms shall.conform to plan; tied and braced. [2606(a)] .
9. Minimum foundation height 6 inches above finish grade. [2907(a)] .
10. Re -bar shall be tied in place. (2607(d)1 .
11 -Provide footing for veneer. Brick ( ),Rock ( 1 [2006(b)] .
12. Water piping on branch to too small. [ 1009 U.P.C.] .
13. Gas piping not permitted under slab. [1213-b U.P.C.] .
14• Mastic required on all metallic pipes where they come through slab or footings. [315 U.P.C.] .
15. Form shall be in place for tub trap recess. It shall be poured monolithic. [803 U.P.C.] .
16. Post lob card [U.B.C. 304(b)I
17•Job not ready for inspection.
Inspector
CORRECT THE ABOVE CIRCLED ITEMS AND CALL FOR RE -INSPECTION
284-233 REV 3/77
d
.�6 `•+"i �+t55411,
,ee , .t = jl ••j .�' a r f i{ - q. 1
' .i. • �,,�`•.•'�+ tr,. } a.�+. ., ' Fes" t •Mf} �� x, - .. '�? • '
APPLICATION FOR`TREE PLANTING' M '
f 'I (we), the undersigned'hereby":certify and acknowledge that I`(we) have'read•the application and agree that if trees are required under River-.
aide County Ordinance No: _457, jhe.appplicant agrees to',install said:trees•priorao final inspyection It-is`,understood that no final.insppaction
will;be given until,said requirements have beenimet or exception•has'.been granted"by ,the County: Now; thereforey'it is agreed tfj9t;the prop:, Gs
or!
owner shall cause"the.property:lines to be surveyedln.the event no survey stakes can''be'.found. Further, it is agreed that tf�`Pe County:of :
,Riverside ahaWa 'r res onsib�li y s o trees h- to`be removed due to lot lin@ errors. fc If F
Owrier�s Name I }' 'O �r €y t" " Bui Iding
y.
Mailing Address y{ - "City' tate 3Zip
Job -Address'
L yol,Deacnption'1 `!" _ '=`'x+ate. z '�. r, r � ,'
�. Gt/L
`Asses iii Map Book 8 -Page �" i Type'Structure'
Type of Soil ��d&
- Is water ovailoble Road De tP Iat Plan`No
,-4 Type of_exishng trees in road ri of -way ' L[ !7/ � -
..ifi^T.7 •alt' :r: " ' *« �7> + •.y^� .4. u.�g;^� Trees preferr c
by appl'ont (1)'~O '- (2) (3) ~
Owners Signature 4
Planning Commission Case
w `k' vROAD DEPARTMENT, APPROVAL'NIP
'
Approved. species `^,.WashinQtonias:robusta (Mexxcanfan palm)YZ-' ~ Number of trees 1
B aci r oftrees `' + s. Distance' frota';lot lines `t:Front�2' ynk'Rjw Side
'Additional`: requirements `� k 'i~ • •�, E Nn.- _
Date Building and Safety notified lso Signatlir.e-
r ^a Z. '^ 't` <'REQUEST FOR EXCEPTION, t
Reason
(attach additional page if necessary)
Request for hearing, 7 YES El
Owner's Signature'
+t (Forward application .to Planning Dept. if exception requested) 7
NO,REQUEST FOR HEARING
Planning Dept.
Concur ff y F Non -concur ❑ Explanation
Date = Signature
Z O
Q Road Dept.
J O t F t • h
IL C Concur 0 Non Concur
�» Date Signature
v Zt. �• ; �'=�j . ' REQUEST FOR HEARING'AND COMMITTEE'DECISION a
F ate hearing established. - ' °`•� '='".'Date hearing noti-ce mailedto owner'` _
tZW �t n s"'.e..r . ~fix w '` 7".?• ':` - �. - �i^ a ` �i a+. •.}t �. yrs .�'�.
►<0 Approved 0 Disopproved ❑ Date Owner notified of decisions y.
.J�:. is •M, yr c i,.,. ,� -
ati. .; Date''Building W..Safety.notified � - - Signature 4,