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CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT -3/2/05:forms781dd-APO.WorR-sheet- <br />if , i <br />PROJECT ADDRESS:2*# A p (010 LT 94' ,SUITE:SAPIN # <br />USE OF BUILDING:RESIDENTIAL COMMERCIAL INDUSTRIAL OTHER <br />NATURE OF WORK:NEW <br />NEW/ADDITION/Al TFRATION <br />' 1ST FL. <br />2ND FL.. <br />, TOTAL OF OTHER FLS: <br />4 GARAGE/CARPORT: <br />C 5 4-rh r 06 M fq' <br />BUILDING 0WNER'S NAME: <br />ADDRESS: <br />TENdrs NAME (Comm/Ind): <br />MASTERID# <br />ADD ALTEFUT.1.DEMO REROOF REPAIR SIGN MISC <br />SF BASEMENT: YES/NO SF NO. OF STORIES: <br />SF PATIO/ENCL. PATIO: SF BLDG. HEIGHT: <br />SF RES. REMODEL: SF PROPOSED USE: <br />SE-d\LTER/T. 1.SF <br />9 N n Alt 06 0 0 9- 60+ezof this application) : ,I ./4 /74,ty_. H·604 -Flh<S C..,Pld,n«2 -60+ t,3 j EL fl ICE....(6 hcL <br />PHONE NO: <br />CITY:STATE:ZIP: <br />PHONE NO: -- <br />JR*®SCRIPTION (non-residential projects see reverse-sid <br />CONTRACTOR'S NAME:STATE CONTR. #:9323/3 L\CENslcgss: 1 60 57 7 297 5-- Pri me 06 ra H €o PIW C) ct i l L PHONE No: <br />ADDRSS CITY:SEP:9 227100 , 6 o?( ) (51 -71/* r 114 6 <br />WORKERS COMP. POLICY#:EXP. DATE: 1 IDISUR*41CE COMPANY:SANTA ANA BUS. LlC. #: <br />A,AVVCDO826-700/ 05'·/241/3 Cio g ! Fi Q rn InS'v Y GACE <br />ARCHITECT/ENGINEER:STATE LICENSE #:PHONE NO: <br />f ADDRESS:CITY:STATE:ZIP: <br />A <br />CONTACT NAME: / A tdy - 772 U 070 2-PHONE NO:760 97*2973 <br />E-MAIL ADDRESS:pi , R ud (E p r ) ry'\ 1 v i r d Q 1 4 .ca vvi <br />OFFICE USE ONLY:ACC OR SPC (CIRCLE ONE)HRS PER BLDG. FEE $ <br />OCC. GROUP:RECEIPT# FIC--« 42--mC-FIEE PD $ <br /> TYPE OF CONSTR:VALUATION: $ _-2 \ .' -1 -F SUBMITTAL DATE-1 <br />\ \9 <br />FIRE SPKR: YES / NO A/C: YES / NO FLOOD ZONE:PROCESSED».4 <br />C \J / <br />RES. DEV. FEE: YES/NO PRIOR DWELLING UNIT: YES / NO COMMENTS: <br />PLANNING OK TO CHECK & DATE BLDG. DEPT. APPROVAL & DATE <br />PLNG CONDITIONS: <br />C-C <br />14-221\9 <br />\ /j