Laserfiche WebLink
PROJECT ADDRESS 3zo.i s SUITE sAPtN# /o /7,31/?e <br />USE OF BUILDING COI/1MERCIAL INOUSTRIAL OTHER &lZ-/34<r{ <br />MASTER ID# <br />NATURE OF WORK NEW ADD ALTER/T,I DEMO <br />/'a ,,7i) <br />REROOF REPAIR SIGN MISC <br />,*ZPz,/1(:7r,4 40 <br />NEWADDIIION/ALTERATION <br />1ST FLOOR- <br />2ND FLOOR <br />TOTAL OF OTHER FLS <br />GARAGSCARPORT: <br />ia a)'/:, SF BASEMENT: YES/NO SF NO. OF STORIES: <br />SF BLDG. HEIGHT: <br />SF PROPOSED USE: <br />SF PROJECT VALUE <br />CE <br />-SF <br />5t- <br />PATIO/ENCL, PAT1O <br />RES. REMODEL: <br />ALTER/T,I,: <br />BUILDING OWNER'S NAN'E PHONENO; 6t* - zt *€ <br />a:2ty'- <br />DDRESS CITY: <br />GrtzZl <br />STATE: <br />1t4 <br />ztP32?, S It"4z. 2a .Z^:p <br />TENANI'S NAME (Commfl nd) <br />4z.tz-PHONE NO <br />CONTRACTOR'S NAME <br />Vzzza z^)a2/1,b.4 <br />STATE CONTR, # <br />A')5,ibL. <br />LICENSE CTASS <br />z z-/ <br />PHONE NO, <br />ADDRESS <br />2l t /.\), /<,il-Z /-.-A 4.e CITY: <br />a44,iY STATE: <br />1'4 <br />ztP: <br />4;+<lzz <br />WORKERS COMP, POLICY#:/t] 42 OJ L - 2../L, <br />EXP. DATE: <br />/o '2t' - 22, I 2 <br />INSURANCE COMPANY <br />5.7112 E,/, <br />SANTA ANA BUS, LIC # <br />ARCHITECT/ENGINEER:2zl2z /jN/z,q'./aL STATE LICENSE #:a75.i tz. <br />PHONE NO?tl-32,2-/'/613 <br />ADDRESS: <br />Z,/ / L).L*;t'--tta ,l*:z- <br />CITY:224.x4-STATEh ztP:/228o-t <br />CONTACTNAME: 6z- /J/z L../4./r.)PHoNE NUMBER: 7t4 .- 3,-7 . .) (: =j <br />E-MAIL ADDRESS; 6t- 4 P2,/-T'>f- 1t-Y.,, <br />PLICANT SIGNATURE: <br />.t r'?3NUMBER: <br />CIry OF SANTA ANA <br />BUILDING PERMIT WORKSHEET <br />PTEASE PRINT APP.O1 <br />OFFICE USE ONLY: <br />OCC. GROUP: <br />ACC OR SPC (C|RCLE ONE)HRS PER BLDG, FEE $ <br />P/C FEE PO $ <br />TYPE OF CONSTR VALUATION SUBMITTAL DATE <br />PROCESSEDFIRESPKR: YES/NO A/C: YES/NO FLOOD ZONE x-b <- <br />RES.DEV.FEE; YES/NO PRIOR DWELLING UNIT: YES/NO COMiTENTS <br />-7- <br />BLDG. DEPT, APPROVAL &PLANNING OK TO C <br />PLNG CONDITIONS: <br />Rev:911U2012 <br />HECK & DATE t. <br />ea r <br />TE <br />t/ / 4.' c- <br />@ <br />JOB DESCRIPTION (non-residential proiects see rsversc aido otlhis applicationl: .74 )-/c, <a'a'..?,'?- (42( )bl/A-)o)/ <br />I <br />RECETPT f _ <br />$-leao--- <br />/t 0