11752 (BLCK)4
4
P.O. 4 No. 11752
BOX 150
Building 78-105 CALLE ESTADO
Address 54-625 Avenida Be=udaS LA QUINTA, CALIFORNIA 92253
Owner Dennis Wish
Mailing BUILDING: TYPE CONST. OCC. GRP.
Address
A.P. Number
City
Legal Description
Contractor Project Description 140' of 6' high block wail
Delia Construction
Addres 201 of 51 high block wall
M22T Hai riling Ave... 125, 9 � of 4' high block wall
City 11,Tela
Venice,, -_m0231 (310)305-1248 -
State Lic. 493782—B-1City -
8 Classif. Lic. # Sq. Ft. P No. No. Dw.
Size. = -Stories Units
Arch:,-Engr.; -
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I' hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
97000) of Division 3 of the,BGsiness and Professions Code, and my license is in full force and
effect.2.1
_SIGNATURE - DATE
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code.' Any city or county which requires a
permit to construct,' alter, improve, demolish, or repair any structure, (prior to its issuance also
requires the applicant for such permit to file a signed statement that he Is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
❑ 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. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or Improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building
orimprovement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
❑ I, as owner of.the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does riot apply to an owner of property who builds or improves thereon, and who contracts for
-such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS', COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance,.or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No! Company
Q'Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (S 100) valuation
or less.)
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 the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter ,the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
(Estimated Valuation $6,232.00
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
i
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line_
Side Street Setback from Center Line
Side Setback from Property Line_
FINAL DATE
INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
C
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
n
IST FL. SQ. FT. ® $
UNITS
SLAB GRADE Ow
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
SEWER OR SEPTIC TANK
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
FOUND. REINF.
GAS (ROUGH)
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
REINF. STEEL
GAS (FINAL)
DRAINAGE PIPING
CAR P. I SQ. FT. ®
GROUT
WALL SQ. FT.
SERVICE
DRINKING FOUNTAIN
SQ FT ®
BOND BEAM3A UL
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GRADING
cu. yd.
$ plus x$
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
I
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC -
WATER CLOSET'
COMPRESSOR HP
POLE, TEMIPERM I
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
LATHING
SO. FT. ® c +
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac I
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE [PL!.CK.FEEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE / PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
01.
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE Ow
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM3A UL
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
4:;;F8cjA C <C I
13 C904 &114z V1 3 c,0
� I��',�
����✓`�f�6��'�0
..�
3ON3 m�-
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION C Z2�
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
)Ifi24/t5, t'l1' 5r�E P _ PAGE 02
_ fwd tyr �'' .,..�- •- .� ��..:::.,.:�
45
,
11�. 4^1 P.O, BOX 1504 APPLICATION ONLY
713.105 CALLS ESTADO
Addrdinl4 LA QUINTA, CALIFORNIA 92253
Ow
r 3 BUILDING, TYPE CONST.
Mellln0 OCC, (SRP,
Afidrotas J� "7 _ Z D t
Glt A.P. Number
y ip
Tot.
V + LoSai Description
two "tor Project Description
! 9
? ddrgas -
r' NA245-
Zip
V =Ilp fill. -
' ti's
& VA elf,641321L 13-iI.IQYq ,q, pt, - No. No, O11I+.
Arch., Enos, She Stories Unite
Designer ( f New ITY`'/n Add Alter Repair n 2 Demolition 2
-city zip =gat 1
�33
t0otltatsftclaa with uctfon
N
OYrMf�4014DlR OQOtAMtION
1 lm"'no I= am ayea+Pt tram the tallor Zoe
tatty !er In! tOIIDwIng
ter! e. real l,tT.Ar.sa A,rR IMe:LRafone MrY t:ar w COtlntfr 11" t e101to.I l
pAnrt GYitrtr0l, alta+, lnprove. s a�o+rr,. er repo or atniahat, t+rh+r to rn (Hunter afiv
MaU•A! dM app#tant Rfr 14411 pannR ro IM r 4lJ td Ptatvoa 4 Mof he b lts�nle Otrri'�tr h
fha ora4tµse,e err ane Contrlorant Lae+rAtr •law. �Appttr 0 foattmtnehp +xt1h 6A,rpvr, lQa1 of
DrrdvAr pat rhs 1%gRrlit Aero ArrNnFARar• :ate, err tMr.M k nswnRt Narofm7h !rM me oral
+tw ft aWpl0 exemPW_ MY tdohffan Or elov lie" o Cy am �ylO��p Ibr a Roma
st,"Vo 4he i $' to It trrwt P•rafty 0%rof mom MN to Mevreo d -s. fsl# 4
I ' I, W awnlr et iha }fr rty, er try esnDlOy!!t w�lh wages �! !Mur pl* GGA1pdnletI", will
d4 Ihs worn ar+A ate t1 Wr! t4 Ae1 It'itp<t!4 eyr plfeleC r�t:lt• f tae4, tMa rssi Rry
k+ortlslatl scar rn• 4bnfraz or'1 lrtnu uw eros• rscr ry to err off+for of aropaay *Or,
burial w Atprores +Hereon !Ao ttrha tlstt ouch wwA parutrfr or mravQa afa own smgfo",
pr0•fi!!q that avoh tntprorlments In rpt inteetrptl err eNlrls ler. rt, rorrerar, rhA H�adGtp
Or A /af0 tY^.hi1 OM Year d t�rthpllRSfn !nl OwYnet•6u',+ler .ay Mra Me bwdln
� Ora�x'l' tMf M a9d nil a..mpror+ tar rhe r:urpaa! or eek.) . -.
t, M owfler of the ptt#pert , r ttxitullrlh ooMrnotlnQ xfih ftOM�ed aanattclorl to am,
alrutt tits prolsol. lslo, bpra, sOlmeae and rr►oraestamr Cow: me COntrecforl lloena4 ten
bolt As! aa,>:y to an lRrM ?I prnoserr who tivAC• a thlp7G"I thlfeOM aRC wM 04Armtlh tW
UrM prtr•et/ w2A ! c". aeterrat two pursuant to me :1onIJOArta L/*J
I am erampt under Sao, _B. ! P.c. for this town
174113 „•„�,.,,,,,,,,�.,.R,Ownar
' wttRrkftB� CR1lrlNaATiGtI DiCIAAATION
I ha eff3rm 1 t t novo oentrtrato of con "I to lelhtnw or a oen,ticaty of
WOAsq s e or a cenInt ;*v lh 70F. *a. 7tf(t�. iaoar Coaa,J
fty•allgt pantr �...,,,� — Is liltd,Milt the ciy. ❑ G+rtmld cLo�py la herel�bgy fumNhgd,
wo v Ct tt41tt►7tlpN 11,91& tAi11CIt
IN's alam7rt neap Pat 6l ceteellrle 6' fha ptdm8 At & snl atwmd dzu-s fs?00) V&POon
w roar 1
I cysMf that In the QartrNtll" of t4 work for wracn mia permit 1! I&N. 1 shO not
teawj or Ca�lflornls in PM r+sentt fo as to tecorna l�a�et to the YVorttlr4' Cimn Wlon
Gats,
SOP"A"M n ter r rr. Met aiiwha Mrs ett as ten yck lnotw oecorns
sub}Ate
to Ma N`Oraon' Ccrn:nno"" orovtW4 of the kot:or Cods, roe must hsrnffm
oon!ptY zh fla3c ptorfarAs err 01%' Penn" tNo 60 o' owd t"kad
CON97RVCTION Ll:NOINo A04hicy
I hgrab�yy afftfm met tharo,ta a Cott esru ,pion It3ndtn0 apgnOy for *A pe'tottnance at t",
wars; tat Vthttpl thea pafMIl la aauve. (Ser, 709?. C41f 4C1t,)
Lardet'6 Nana
6lydtr'4 A40
Title to � Dulldlnp tNftMI wnaA pft31Taf9 111146 out, sf{tnW lr,d ratl;fatad, i1n0 Is gtlA}es1 to
lzptrotlon 1f •ear" thmtthtdar,i autpensed fat 140 d*ye,
I caftlly that I herrt� lead thio apoltoation ani slut lh$t tho ol;*Ve in} ,talon Is ec4
t eg,vt to eomply IIh All city ens eaunly er¢tteAeee end $14, IaWN rahittty to 0=9tng
i cenitn,cftpn entltrllsy eufhorltA taivaaanta:Ives ,21 lftll arty to Quilt ltb req
'' �rtloned stvplre� lot intimilan ;v"4c
���, ;drpnatur! of app�u►r,f.,,-.,„;, — - .. p��
- •. M.alpnp Atldrha]�e - _
�l��i,i•r'-iT„W,r'�a '- A .���"*.-�w-s� \",,,.,' i 'i�'w''S"�YA'�” �`i
V O ,3
PERMIT
moon.
!I Electrical
G di
Drivel
3922• �-
AMOUNT-
moon.
MOUNT-
. e
ZONE: 6Y:
Minimum Setback Dlatan"ee-
Front Setbaok from Center Line '
- Repr tstback from Rest Prop. Line
Side Street Se=ck from Center Line,_„_.'.,,,.;._.:_
Side,S&Wi:K from Property Line--------
FINAL, DAT£''' INSPEGTOA
t
180uod tyy: oate---pormlt
f;•xp«u�i ,�tAa.�t;�R tea,.... . in.Y+a.`--' ...�....�.Y. +„zk�d..r�:�:—i.'-�"_�_--:
f
t
,.a.,s. „ __ r.Av xr MiwwwYsr,p9."►rRf'v - - ' j • .
i
..
i
Building
ner
Mailing
Address
A.P. Number -77Y "�0Z — rDi
Zip Tel. Z
` Legal Description
Project Description
ty lZip I Tel.
State Lic. City
& Classif. Lic. #
Arch., Engr.,
Designer
AddrPR.% I Tel.
CityZip State '
C k)
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm 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.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
1 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. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
1 1 I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
,1 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
[7 Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT., U, after making this Certificate or Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
BUILDING DIVISION
Sq. Ft.�� 7` N0. No. Dw.
Size Stories Units
New Add ❑ Alter ❑ Repair ❑ Demolition ❑
;timated Valuation r r 2, 3 15ICJ! r bO
PERMIT { e AMOUNT
Plan Chk. Dep. 2 iv '—
Plan Chk. Bal. 2
Const. i Ito
Mech.
Electrical
Plumbing 4►Q
S.M.I.
Grading W,cro
Driveway Enc. .�—
Infrastructure Z 2
qo ~. C
nnca nn n r'T-Yr. t 4
_4 7_07 4 (�
TOTAL is -`SAN 3.`�T[ TAL I 215.00
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DA
INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
GROUND PLUMBING
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. @ ;
SLAB GRADE
UNITS
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
YARD SPKLR SYSTEM
ROCKSTORAGE
2ND FL. SO. FT. �r
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEGUIP.
REINF. STEEL
GAS (FINAL)
f
�t� �7
MOSILEHOMESVC.
BAR SINK
WATER HEATER
POR. SO. FT. @
FINAL INSP.
BOND BEAM
WATER SYSTEM
GAR. S0. FT. @
=$
POWER OUTLET
ROOF DRAINS
FRAMING
FINAL INSP.
ROOFING
DRAINAGE PIPING
CAR P. SO. FT. a
VENTILATION
WALL S0. FT. @
FIRE ZONE ROOFING
DRINKING FOUNTAIN
SO. FT. @
SPARK ARRESTOR
URINAL
ESTIMATED CONSTRUCTION VALUATION $
LATHING
WATER PIPING
NOTE: Not to be used as property tax valuation
MESH
FLOOR DRAIN
INSULATION/SOUND
MECHANICAL FEES
FINISH GRADING
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
FINAL INSPECTION
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FENCE FINAL
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GARDEN WALL FINAL
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
I TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
I POLE,TEMlPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. @ c
BATH TUB
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
S0, FT. RESID @ IIA c
s
SEWAGE DISPOSAL
SO.FT.GAR @ ?bc
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEEPL.CK.FEE
CONST. FEE
ELECT. FEE
SMI FEE
PLUMB. FEE
/I X1IfV
STRUCTURE PLUMBING ELECTRICAL HEATING R AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEGUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated (619) 347-8631
Date 1/5/93 1 Type of Permit I La Quinta
No. 111948 1 Permit #
Owner Name Dennis S. Wish Log
No. 54625 Street Avendia Bermudas
city La Quinta Zip 92253 Study Area 110
APN # 774-285-013 1 Tract #I I Lot # 0 Square Footage 11954
Type of Development Single Family Residence INo. of units
Comments
At the present time, the Desert Sands Unified School District does not collect fees on
garages/ carports, covered patios/ walkways, residential additions under 500 square feet,
detached accessory structures or replacement mobilehomes. It has been determined
the above-named owner is exempt from paying school fees at this time due to the
following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080
in the amount of 1.58 X 1954 or $ 3,087.32 have been paid to D.S.U.S.D. for
the property listed above and that building permits and/or Certificates of Occupancy for
this square footage in this proposed project may now be issued.
Fees Paid By Dennis Wish Telephone
Name on the check
By James E. Lively
Assistant Superintendent, Business Services
Fee collected /exempted by Vickie J. Durrett u
Payment Received
Signature - ePieck 44o. 138
Collector. Attach a copy of county or city plan check application form to district copy for all waivers:
Embossed Original- Building Dept./Applicant Copy - Applicant/ Receipt Copy - Accounting