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HomeMy Public PortalAbout5010 MCCLINTOCK AVE_Building__ vzkpAtiTlvMNT of BUILDING AND S Yl'b "5 "3 AYYLL% L°111V1V iVii Y8S1v111 s� COUNTY OF LOS ANGELES { 1 WM. J. FOX, CHIEF ENGINEER-4' B U I L Ul N G FOR APPLICANT TO FILL IN FOR OFFICE:USE ONLY BUILDING /IV DISTRICT NO. PLAN CIC.NO. PERMIT NO. ADDRESS LOCALITY IVY 0 A/ 7AF RED V D BY DAT OF APPL. DATE ISSUED NEAREST CROSS 2— CROSS ST. 1 -1✓ �^ s\ / 1 1 49 ADDRESS C),✓� SC 'D �� OWNER )�7 MAIL )) L L ' J n -_ ADDRESS, 3 /3 "J w� v ,� ` , `LOCALITY f- 111 NEAREST TEL- 'CROSS ST. CITY V 4\ f U(G i+ N13. /V !`/ /� FIRE NS TYPE GROUP' ARCHITECT R " TEL. ZONE..► ENGINEER NO. �(,j� L� pp'���/` �f( BLDG. ORD.NO. ADDRESS a':;/n hf�vp/ �' t7f.�a O �{.r 8ETBACK`LINE • J yT� APPROVED- CONTRACTOR / PPROVED-CONTRACTOR Q V r4� ,D )?, (� ITW. II 0 �� BY DATE USE'1 f° )� / s.y i ZONE /1 APPROVED BY DATE -ADDRESS. h � ,] 17 /.,_,/ .+� rw / LEGAL 1,6067 2"f s' g/ CORRECTIONS DESCRIPTION LOT NO. BLOCK �- nn,^ �--..w.-�,, l TRACT , _,// 0 ���k/Y i 6 O /b SIZE OF LOT S (d 1 NO.OF BLDGS.- / ` Y .3` a-LI NOW ON'LOT _ .NO.OF • NO.OF EXISTING BLDG. -FecrnLrE9---`R'OOMS �� f AS)A..)0 6i pry DESCRIPTION OF WORK -Pave NEW ALTERATION ADDITION O REPAIR MOVING DEMOLISH p - Sq.FT. NO..OF Z SIZE Q ROOMS W STORIES s WALL 1� r COVERING 1.,, I COVERING J`ryg��Q, i� USE OF NEW �'jI /�{ J BUILDING V ` /J - 1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPROV S APPLICATION AND TATE THAT THE ABOVE IS CORRECT FOUNDATION:LOCATION INSPECTOR DATE, AND AGREE TO A COMPLY WITH L}' COUNTY ORDINANCES FORMS,MATERIALSI AND STATE LAWS REGULATINGI LDFG C NWUCN.crY���s (/j`Y\JFRAME:FIRE STOPS,SIGNATUREOF YBRACING,BOLTS OWNER LATH,INT.: AUTHORIZED AST- LATH,EXT.: DB,S 25M s 3 4-a7 $•_, P.C.S p PLASTER,INT. �f�, ®� FEE S..f. PLASTER,EXT. _ � 13 { V " VAL ATION �wZ r FEE FINAL ,Jw-DEPARTMENT OF BUILDING AND SAF 25 ' "BUILDING PLICAT O� ,OR PERMIT COUNTY OF LOS ANGELES B U I Lm®I N G •.WM. J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRICT NO. PLANCK. NO. �JPERMIT NO. IILD ADD EISSd. f'!. �' l.y •'t ' ! �1 �A f�P � J L // So `7 CJ y �A RECEIVED BY DATE OF APPL. DATE ISSUED LOCALITY CNEAREST ROSS$T, pN6� ����. BUILDING e OWNERC�� !vl'� ADDRESS MAIL _ - ' 5 LOCALITY V J d T♦ C• ADDRESS_ r, NEAREST TEL. p� CROSS ST. • �jQ' � CITY NO. {11 =IRE NO. OF ONE I PLANS _:I TYPE I GROUP ARCHITECT OR TEL. ENGINEER NO. BLDG. RD. NO. SETBACK LINE Z.d ' /Ire ADDRESS APPROVED - TELBY DATE CONTRACTOR A uj N B P NO. ZONE / � APPROVED BY DATE ADDRESS HOUSE NUMBERING LEGAL DESCRIPTION I LOT N06,��j� L�CI�r 4-07 MAP NUMBER 2-4.7 FIELD CHECK BY T RACT NO. ASSIGNED BYE— DATE f t No. OF SLDGS. CORRECTIONS OT ,"�r/j rr [ �� I NOW ON LOT NO. OF I BLDG, FAM��1es Liu DESCRIPTION OF WORE II ALTERATION I I ADDITION O I DEMOLITION +--/� NO. OR�D O ROOMS STORIES _. WALL ROOF r COVERING (D f- M E j-j.004 COVERING Q,(JP'!PO USE OF STRUCTURE p APPROVALS, INSPECTOR'S SIGNATURE DATE I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FOUNDATION: LOCATION PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS CORRECT. I AGREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME: FIRE STOPS, HEREON AND WITH ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS "'Z-Y►"+Z '� -v LAWS REGULATIN BUILDING C ONSTRU�CTION. r , FURNACE: LOCATION, SIGNATURE OF 'o J GAS VENT, DUCTS PERMITTEE C�9L� C LATH, INT. ADDRESS-��>'D /F�j� /'Y���t(!J...1.•1-��-�� (sf.-'f•�.�� LATH, EXT. AUTHORIZED AGT. PLASTER, INT. 78A878A•D923 10-80 .$ fF . C. 1$ EE PLASTER, EXT. VALUATION EE $ G FILIAL 4F/-); --7 rL 1` WORKERS'COMPENSATION DECLARATION I, sreFly affirm that I have certificate of consent to self insu APPLICATION FOR BUILDING PERMIT .- insure, or a certificate of Workers' Compensation Insurance, Vr a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY R5IieyNd. Company BUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS D�' C7 C ,L/A,/T e ❑ Certified copy is filed with the county building inspec- FADDRESS DING i C tion department. ` ©`Date Applicant `^� E IP LOCALITY NO. F BLDG . NEARESTCERTIFICATE OF EXEMPTION FROM WORKERS' OF LOT NOW ON LOT CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100)or less.) TEL. USE ZONE MAP �l OWNER NO. 14 OC I certify that in the performance of the work for which this SPE CIAL -7permit is issued, I shall not employ any person in any manner ADDRESS G e_(_-1&TFz> kCONDITIONS a so as to become ubject to the Worker' mp sation Laws. �p O Date// CITY �Q L IP CA A U Applicant G ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE OCESSED BY O NOTICE TO APPLICANT: If, after making this Certific a of ENGINEER NO. CONST. ZONE �/ Compensation you should become subject to the Workers- St b� f�3 I ' a. Com ensation provisions of the Labor Code; you must forth- ADDRESS "•� with comply with such provisions or this permit shall be �` TEL. STATISTICAL CLASSIFICATION APT. CONDO. Z deemed revoked. CONTRACTOR i. NO. _ LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. E MAP (commencing with Section 7000)of Division 3 of the Business CITY CLASS LIC. SEW and Professions Code,and my license is in full force and effect. BK PG. VALIDATION SQ. FT. NO. OF NO.OF CHECK License Number Uc. Class SIZE �t� STORIES FAMILIES ONE V6WATION19 Ic o0 Contractor Date DESCRIPTION OF WORK NEW ❑ El am exempt under Sec. A N l( � � taw-em ADD El $ Poo. EJ B.&P.C. for this reason REPAIR 1:1 $ Date: USE OF EXISTING BLDG. DEMO' ❑ Signature APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION (PRINT) NO* DATE n n I hereby affirm that I am exempt from the Contractor's License r' Law for the following reason (Section 7031.5, Business and ADDRESS FINAL AC Prgfessions Code): PRESENT By BUILDING ACCT.AT as owner of the property, or my employees ees with ADDRESS wages as their sole compensation,will do the work and LOCALITY ; 3 7 124 e Uv the structure is not intended or offered for sale(Section 1 7044, Business and Professions Code.) MOVING TEL. 1 ITEMS ❑ I,as owner of the property,am exclusively contracting CONTRACTOR NO. -e+� with licensed contractors to construct the project (Sec- ADDRESS TOTAL -1 24 io 1�� tion 7044, Business and Professions Code.) REQUIRED TOTAL SETBACK FROM EXIST. CHECK 124.88 CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT CHANGE .00 the performance of the work for which this permit is.issued flnvestigation (Sec. 3097, Civ. C.). Lender's Name 0000'0001 9/11/891 $ � LDMA Ref.# i {.� ee$ Permit Fee r , IS 1 A!1 :+t i Lender's Address ° SK I certify that I have read this application and state that the Issuance Fee + LDMA P/C# Babove information is correct. I agree to comply with all County Fee ordinances and State laws relating to building construction, Total Fee v LDMA Perm. # and hereb author'ze representatives of this County to enter upon t ove a ned operty for inspection p rpos. ���� SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applican or Agent Date WORKERS' 7 PENSATION DECLARATION uuu APPLICATION FOR BUILDING PERMIT "p'hereby affirm that I have a certificate of consent to self insure, Cr a certificate of Workers' Compensation Insurance, ora certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Nilig4 No' Company ElBUILDING /16—VrO Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS / ❑ Certified copy is filed with the county building inspec- BUILDINGC Tion department. ADDRESS CITY I&U l' C� ZIP C LOCALITY Date Applicant NO.OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. t COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one, TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100)or less.) TEL. OWNER ^O'Z NO. U NE NOP / '—�7 1 certify that in the performance of the work for which this t/ J�,l SPECIAL permit is issued, I shall not employ any person in any manner ADDRESS ,$Q C e,t_L r C3 K �{- I CONDITIONS IL so as to become subject to the Work Co ensat'on Laws. U p�1Z - CITY Te 'rL e r— ZIP 0-4- l3 U Date o 2ro ,Applicant .ARCHITECT OR TEL. DIS7RICi GROUP TYPE FIRE SED BY O NOTICE TO APPLICANT: If, after making this Cer e o ENGINEER NO. ,/. �� CONST. ,ZONE t U Exemption, you should become subject to the Workers' ✓Gi Compensation provisions of the Labor Code, you must forth- ADDRESS a with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. I CONDO. Z deemed revoked. CONTRACTOR NO. Z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO.92V DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. ommencing with Section 7000)of Division 3 of the Business LIC. SEWER MAP (-Ed Professions Code,and my license is in full force and effect. CITY CLASS BK PG (0 VALIDATION SQ. FT., Q ! NO. OF NO.OF CHECK L.nse Number Lic. Class SIZE Z STORIES FAMILIES ONE VALUATION Contractor Date DESCRIPTION OF WORK NEW ❑ ; � 10 ❑I am exempt under Sec. �D 1 [ eW b ki- alte" ADD •Q , 01 ALTER ❑ BAP.C. for this reason REPAIR ❑ $ Date: USE OF EXISTING BLDG. DEMOL ❑ Signature APPLICANT TEL. AL OWNER-BUILDER DECLARATION (PRINT) NO DATE n I hereby off irm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FINAL Professions Code): PRESENT By property, BUILDING _ p41Tog 1, as owner of theor mY em to employees with ADDRESS '� r wages as their sole compensation,will do the work and LOCALITY �.7� �; 3317 11�re Vii! the structure is not intended or offered for sale(Section 7044, Business and Professions Code.) MOVING TEL. 1 ITEMS El1,as owner of the property,am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS TOTAL J.24 o 88 tion 7044, Business and Professions Code.) X CASH 124.88 REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH oCICi I hereby affirm that there is a construction lending agency for FRONT CHANGE the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE Lender's Name P.L. GWO-0001 8/29/89 S P.C. Fee$ Permit Fee ( / '� LDMA Ref.# , 5369 1 Aft 92-11 Lender's Address 7 I certify that I have read this application and state that theIssuance Fee -� LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee u LDMA Perm. # and hereW9 authorize representatives of this County to enter upon t -oveentione operty for inspection urpo�eS. 47-9 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Date r WORKERS'COMPENSATION DECLARATION 1 'V re,tor°a certificate of Wbrke s'ffirm that I have a' tificate Compensat on Insuranc self, '. AP P L LCAT_ I O N FOR. BUILDING PERMIT 4orof consent to'a certified copy thereof(Sec. 3800, Lab. C.) J. ;COUNTY O.F LOS.ANGELES BUILDING AND SAFETY � Ficy Nod Com any. BUILDING 0 Certified copy is hereby furnished. FOR.'APPLICANT TO FILL IN' - ADDRESS C11 ej L a4—i•49 nj ❑ Certified copy is filed with the cou ty buildi g inspec- BUILDINGC r tion departm nt. ADDRESS 'Date Applicant CITY ol� ( ..ZIP _ /� LOCALITY I= N OF BLDGS. NEAREST -� ` .'CERTIFICATE OF,EXEMPTION FROM WORKERS' SIZE OF LOT N W ON'LOT CROSS ST. ��! , COMPENSATION INSURANCE ASSESSOR ' (This section need'not be completed if the permit is fog one ' TRACT-' BLOCK LOT NO. MAP'BOOK ­ - PAGE PARCEL " huridred'dollars ($100).or less.) TEL' USE ZONE " MAP OWNER O. L NO. I,certify that in the.performance of the,work for which,.this SPECIAL permit is issued, I shall-not employ any person in any manner ADDRESS: CONDITIONS_ CL so as to become subiect to the-Workers Compensation Laws. j OO CIN ZIP Date Applicant ARCHITECT•OR TEL. NOTICE TO APPLICANT: If, after-making this,Certificate of ENGINEER'..• -' NO. DISTRICT.. GROUP TYPE FIRE )CEj);Z BY O CONST9 / ZONE I— Exemptiori, ybu,should,•become subject 'to the Workers' V U Compensation provisions of the Labor Code, you must forth- ADDRESS ".' - ✓+alJ �� 3 a- N with comply with ,such-provisions. or this permit shall be •TEL• STATISTICAL CLASSIFICATION APT. CONDO. Z deemed revoked. CONTRACTOR NO. _ LICENSED CONTRACTORS DECLARATION LIC. CLASS NO: _DWELL. UNITS ADDRESS NO. I hereby affirm.th'at I am'licensed under Provisions of Chapjer9 - - SEWER MAP .(commencing vi ith.Section:.7000)of Division 3.of the"Business LIC: • and Professions Code,and my license is in full force and eff•ect. CITY CLASS BK PG VALIDATION SQ. FT. NO.OF NO. OF CHECK ' License Number' y .Lic. Class SIZE ] STORIES•' FAMILIES" ONE " VALUATIONN/� Contractor- Date DESCRIPTION OF WORK NEW 1:1 $ VDZ u VT.o 'ADD' ❑ pop,am exempt under Sec. Q B.&P.C. for'this reason '1 I "� lC. REPAIR ❑ $ ' Date: USE OF EXISTING BLDG.. 'DEN101 ❑ Signature APPLICANT. TEL. FI - (PRINT) NO .. OWNER-BUILDER DECLARATION TE .• r-c; I hereby off irm that I am exempt from the Contractor sticense _ Law-foe the following reason (Section 7031.5, Bus'ines's and'• ADDRESS FINA Professions Code): j PRESENT By I _! �• s BUILDING -4�i v ❑ I, as-owner' of-the property, be my employees.With ADDRESS' 4a�1 wages as their sole compensation,Will do the wofk and the structure is not intended or offered for sale(Section ' [ADD' LITY . 1 ITEM 7044, Business and Professions Code.) ING "TEL. .. ... ❑ I, as owner of the.property;am exclusively contracting TRACTOR NO. —� -t V�lyl �-�a 50 with licensed contractor's to construct the-project (Sec- __—.--- - V a.P tion 7044, Business and Professions,Code.). ESS. I'� �oQ QUIRED TOTAL SETBACK FROM EXIST, ruA`;� r. CONSTRUCTION LENDING AGENCY BACK YARD HWY PROP. LINE WIDTH 4ru11'! �v(-1 ' I hereby affirm that there'is a construction lending agency for ONT the performance of the work for which this permit Js issued . (Sec. 3097, Civ. C.): E. - Lenders Name . -101i �h9,t�l�r14/89 3 LDMA Ref.# 56� 1 A t. 90-31 Fee$ Permit FeeLender's Address I certify that I have read this application and state that the Issuance Fee LDMA P/C# above Information is correct.9 agree to comply with all County tigation Fee. ; ordinances and State laws relating to building construction,' Total Fee 1461.5. LDMA Perm. It and her�Wve thori representatives of this County to enter upon th - tione ' r erty for inspection4,Urses. ; o SEE REVERSE FOR EXPLANATORY LANGUAGE gnature of Applicant or Age Date r • APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS 570 L O SGL r krrve- r At I hereby affirm that I have a certificate of consent to self insure, [B7UILDINGADDRESS 'or a certificate of Workers' Compensation Insurance,or a certified Cm � ,� �� C copy thereof(Sec.3800,Lab.C.) ITY r ZIP A 7� Policy No. Company QLu •: (2 L C�• �/ LOCALITY IL SIZE OF LOT NO. F BLDGS.NOW ON LOT El Certified copy is hereby furnished. $6 K }� NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. ASSESSOR MAP BOOK PAGE PARCEL USE ZONE MAP NO. Date Applicant 2 et7 SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEjL�N'O`. �Tt T1 r,. COMPENSATION INSURANCE 1 �U `TYL Z 7L WITHIN 1000 FT.OF SCHOOL? ves No (This section need not be completed if the permit is for one hundred ADDRESS P �A i 0 pit l e , r7TcC� DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100) or less.) VVL {'en- iV l� 1 certify that in the performance of the work for which this permit CITY ,f t4 ZIP � eA4• is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGIN R TEL NO. become subject to the Workers'Compensation Laws. ! ,�r,7f STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS] WY— f � CLASS NO. DWELL UNITS NO77CE TO APPLICANT.' If, after making this Certificate of `A � '3�� �—�V'� � REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONTRA TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith Vb FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS `, I LIC.NO. PL LICENSED CONTRACTORS DECLARATION �"� ��[.I�c SIDE CITY LIC.CLASS PL I hereby affirm that I am licensed underprovisions Of Chapter 9 �"� e' SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.O STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. J(1 NEW ❑ BK PG ® a License Number Lic.Class QPSCRIPTION OF WQRK ADD ❑ VALUATION C Contractor Date V LO i•�6 0 �y l ALTER ❑ $ El[II am exempt under Sec. REPAIR ❑ $ H iD B.&P.C.for this reason DEMOL LDMA P/C# gti�.T a LL Date: USE OF EXISTING BLDG. URM ❑ hi`�e T.# ie/ O Signature APPLICANT(PRINT) TEL NO. LDMA Perm# ' LUf 13't>,V4 2 ❑ I, as owner of the property, or my employees with wages as Z their sole compensation, will do the work and the structure is ADDRESS O not intended or offered for sale (Section 7044, Business and FINAL ATE C ACCT,v TEMS jProfessions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL "�'•' L{T I, as owner of the OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE a :;3 I7 ���o v.• \ property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FI BY n licensed contractors to construct the project (Section 7044, YES f j Business and Professions Code.) WILL ❑ No❑ +- WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH TOTAL AL .43 CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR t GUIDELINES CHECK 310.413 1 hereby affirm that there is const ction lending agency for YES❑ No❑ N the performance of the wo k r whi this permi 's issued(Sec. CHANGE .00 w I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING 3097,CIV.G.) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE. N TITLE 2.CHAPTER 2 20 SECTIONS 2 20.100 THROUGH 2 20.140 CONCERNING HAZARDOUS Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. C3 Lender's Address .�Ir� "CC,L/iV�de 3/10/93 0 OWNER OR AGENT oI certify that I have read this application and state under penalty 593 1 AM :354 0 of perjury that the above information is correct.I agree to comply P.C.FEE L/� (! PERMIT FEE O CY with BID county ordinances and State laws relating to building /7 /• �a construction, and hereby authorize representatives of this County ISSUANCE FEE - / to enter�fi th above ntioned property spection purposes. (� CD �/67— �> INVESTIGATION FEE TOTAL FEE /,�;P/ V SEE REVERSE FOR EXPLANATORY LANGUAGE