04-0917_ZARIFI, SIMA_Cash Deposit Receipt0 0
Plan Check Application No.
Permit No. %eg*&J >
CITY OF
SAN JUAN CAPISTRANO
MISCELLANEOUS RECEIPT
Project Name
Project AddressZZ !/!� �%��r✓'
Applicant �mGl/ Phone 6P%9 14t5e;�,J
Address
Building Plan Check ...................................................... $ (01-4411)
Grading Plan Check ...................................................... $ (01-4413)
On -Site Plan Check ...................................................... $ _ (01-4413)
Special Inspection/Re-Inspection.................................. $ _ (01-4412)
Geotechnical/Soils Plan Review .................................... $ (01-4419)
( ) Copies @ 0.20/ each ........................................
Other ....C-'. .........
TOTAL.....................................
(01-4521)
$ l/ 74-Ae. 450
'5o
NOTE: APPLICATIONS FOR WHICH NO PERMIT IS ISSUED WITHIN 180 DAYS FOLLOWING THE
DATE OF APPLICATION/DEPOSIT SHALL EXPIRE BY LIMITATION AND BECOME NULL
AND VOID. UNIFORM BUILDING CODE SECTION 304 (d)
Prepared By
Department of Engineering
Date
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