HomeMy WebLinkAbout201 EASY PL; ; 69-9M10; PermitSTATE OF CALIFORNIA
Dep9liirent of Housing and Community Development
Division of Building and Housing Standards
APPLICATION FOR PERMIT TO CONSTRUC;
BUILDING-PLUMBING-ELECTRICAL
CO -ID No.-
SHL •
EPL •
MP •
Acc/s n
TO BE COMPLETED BY APPLICANT ^9- 9M/0 DIVISION USE ONLY
(COMPLHE IN TRIPLICATE—PLEASE PRINT)
.5^iLAM/^/^ t<^o-^iuc? /F^rMr^
Location_
Owner
Address.
Applicant
Address.
Workmen's Comp. Certificate Verified.
Approved:
Project Owner/Operator
(Required for accessory structure, mobilehome park)
Lots: Indep.. -Dep..
MOBILEHOME PARK
_Acc. Structure
BUILDINS
.......... -.-5, P./^. /^?&.u/f P^Tjo ^ ^/^e/^^r
Sq. Ft ^60i^H~, Stories_
Accessory Building: Type_
Fixtures/Sewer lnlets_
Main Sewer
PLUMBING
Flre Hydrants_
.Private Sewage Disposal.
water Heaters_
Water Piping
_Gas Outlets-_Gas Regs_
JMt/Rep_ -Sprinkler-
Backflow Preventers--Other-
Outlets-
ELECTRICAL
-Fixtures Motors (HP)_
Generators (KVA)-
Ranges/Heaters
MH Lots___
_Merc Lamps-
-Signs-
Over 600 V_
-Service: 200 AMP or less_
Other
-Fire Alarm System
Over 200 AMP_
I hereby acknowledge that the information I have provided is correct and agree that all construc-
tion shall be in accordance with applicable provisions of the health and safety code and related
rules and regulations of the State of California, and on behalf of the owner, I herewith consent to
all necessary inspections incident to the issuance of this permit.
Date —Applicant X
(^hrc^c^zA^^ C/3^c\ Plan Check Fee due with application—Not Refundable.
Distribution: Orig. to Area Office, I DR, 1 Applicant
HCD FORM SOIA (REV. 3-68)
Prior l ocal Approval:
Flre Department jlfly % ^-f/Ci
Health Department
Planning Comm
Other
'^98
Type.
Tvpe J*
^UILDING
-Val. /.'^*r V -Val
-Val
Fee
*0
BUILDING PERMIT FEE
PLUMBING
No. Item Fee
Put. Di.'ip. Sys
f.i% OutlRt.';
Wafer Piping
Alt/Rep
PLUMBING PERMIT FEE
ELECTRICAL
No. Item Fee
Outlets
Motors (HP)
Generators (KVA)
Mem lamps
MH Lot Equip
ELECTRICAL PERMIT FEES
ISSUANCE FEES
Total Permit Fee ,
Total Fee
3.0 0
Fees Received:
DR_
Approved: C / Area Supervisor A OSP
DATE. JIU4-
CUSTOMER AnnRP<;<^'^ rs / -Q^ff^ Sf^-
CUSTOMER NAME
CITY OF CARISBAD
APPROVBD
r OulUtirg IWt^.
SPACE NUMBER
CITY
ENFORCEMENT AGENCY.
DEPARTMENT OF BUILDING AND SAFETY
STREET LOT NO.
NAME OF PARK
PARK MANAGER'S^THORIZATION TO INSTALL ^ V if O f^/^ fj a
NOTE:
PARK BUILT PRIOR TO 10-16-65 Yes No.
PARK MGR'S SIGNATURE