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CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT <br />PROJECT ADDRESS: 1 4 06 K[6010 542-, ,SUITE: <br />USE OF BUILDING: k*ESIDENT2)COMMERCIAL INDUSTRIAL OTHER <br />3/2/05:forms/Bldg.APP.Workshi <br />SAPIN #/0 / 7 9.2 40 <br />MASTER ID# <br />NATURE OF WORK: NEW - QADD ) ALTEFUT.I.DEMO REROOF REPAIR SIGN MISC <br />NFW/ADDITION/Al TFRATION· <br />1 ST FL.. SF BASEMENT: YES/NO SF NO. OF STORIES: <br />2ND FL.. SF PATIO/ENCL. PATIO:SF BLDG. HEIGHT: <br />TOTAL OF OTHER FLS: SF RES. REMODEL:SF PROPOSED USE: <br />GARAGE/CARPORT: SF ALTER/T.I.SF <br />JOB DESCRIPTION (non-residential projects see reverse side of this application) :17--af lopt ov n.*71- 4 s.( CA v pho'fl>l,of·-t:de_ VM,ool,u Le 3 <br />BUILDING OWNER'S NAME:PHONE NO:06 aDA , 6AE {301<ID 07/43 5Lt-7 - 355-7 <br />ADDRESS: ZIPUj 1.-/ -04 kUSmj DE...*u-(A AIA STA* <br />TENANT'S NAME (Comm/Ind):PHONE NO: <br />CONTRACTO NAME: ,STATE CONTR. #: <br />TWA 1-AN 01 U 97059 / <br />ADDRESS'CITY -2-15 l-l" l_AN -\6-aft[ ·124 STUR -B€Ek <br />LICENSE CLASS:PHONE NO: <br />6 446 626 -39045-8-4 <br />WORKERS COMP. POLICY#:EXP. DATE:INSURANCE COMPANY:SANTA ANA BUS. LlC. #: <br />ARCHITECT/ENGINEER:SIATE LICENSE #:PHONE NO:04 (er UU 9-7/754 I 7/4--676-3765 <br />ADDRESS:S-1-24* ciapt STATE ,ZIP:411 6/ UU£EP@ r24.-044 92,€-2-( <br />CONTACT NAME:AOMM, C-flt/PHONE NO:2520- 370.-,Ag &-6 <br />E-MAIL ADDRESS:JU\rt.,(3-+rU Q/FOU/2-vED(B-4-- ' CO- <br />OFFICE USE ONLY:ACC OR SPC (CIRCLE ONE)HRS PER BLDG. FEE $ <br />OCC. GROUP:RECEIPT #- P/C FEE PD $ <br />TYPE OF CONSTR:VALUATION: $/20eo SUBMITTAL DATE: <br />FIRE SPKR: YES / NO A/C: YES / NO FLOOD ZONE:PROCESSED <br />RES. DEV. FEE: YES/NO PRIOR DWELLING UNIT: YES / NO COMMENTS: <br />PLANNING OKTO CHECK& DATE BLDG. DEPT. APPROVAL & DATE <br />PLNG CONDITIONS: <br />1 'S <br />Z