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CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT 3/2/05:forms/Blda.App.Worksheet <br />PROJECT ADDRESS: 1(23 .Cabh*Itt Pork Dr SUITE:SAPIN #10114512- <br />USE OF BUILDING:REEkfiX- COMMERCIAL INDUSTRIAL OTHER <br />MASTER ID# <br />NATURE OF WORK:NEW ADD 2EaN. DEMO REROOF REPAIR SIGN MISC <br />L__--> <br />NFW/ADDITION/Al TFRATION· <br />1ST 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) :*off MOU·V\1-01 4,) LE p,Me!5 <br />l L poilel 5, 4 ·6\ct. <br />BUILDING OWNER'S NAME' <br />5 011# ortl <br />PHONE NO: <br />Allard 712 <br />ADDRESS:CITY: )STATE'I i 1 3 6%brillb -P•rk- P r ban-14 A,44 0/1 <br />TENANT'S NAME (Comm/Ind):PHONE NO: <br />CONTRACTOR'S NAME:STATE CONTR. #:LICENSE CLASS:Oblar C k,f -Bn,04 <br />ADDRESS:CITY:STATE: <br />2(65 5 6,4 AUL,9* AL 14- C 4 <br />5 43 -1173 <br />ZIP <br />9 270© <br />PHONE NO: <br />ZIP: <br />92706 <br />WORKERS COMP. POLICY#:EXP. DATE:INSURANCE COMPANY:SANTA ANA BUS. LlC. #: <br />96-7346-76¥8/11 13 Zur tell <br />ARCHITECT/ENGINEER:STATE LICENSE #:PHONE NO: <br />ADDRESS:CITY:STATE:ZIP: <br />CONTACT NAME:-Tbm,vty DAM <br />E-MAIL ADDRESS: -|-61£41& (83 4.dr-CE-+7 ./ 0"10_-1 - /-- <br />PHONE NO: 7,4- TZ,4-9764 <br />OFFICE USE ONLY:ACC OR SPC (CIRCLE ONE)HRS PER BLDG. FEE $ <br />OCC. GROUP:RECEIPT #N \ A P/C FEE PD $ <br />TYPE OF CONSTR:VALUATION: $/Gooo SUBMITTAL DATE: <br />FIRE SPKR: YES / NO A/C: YES / NO FLOODZONE: . PROCESSED <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 />,