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PCC-13 Rev. 06-17-2019 White-Plan Check Yellow-Applicant <br />REVISION /SUPPLEMENTAL <br />PLAN CHECK REQUEST <br />PCC-13 CBC 2019 Rev 4/2022 <br />Planning & Building Agency <br />Building Safety Division <br />20 Civic Center Plaza <br />P.O. Box 1988 (M-19) <br />Santa Ana, CA 92702 <br />(714) 647-5800 <br />www.santa-ana.org <br />Project Address: _________________________________________ Suite #_______________________________ <br />New Plan Check No.____________________________________________________________________________ <br />Original Plan Check No.:__________________________________ Permit Issuance Date:____________________ <br />Original Plan Checker:__________________________________________________________________________ <br />Amount Paid: $__________________________________________ Misc. Receipt #: ________________________ <br />Processed by:___________________________________________ Date:________________________________ <br />Plan Checker Approval:___________________________________ Date:________________________________ <br />Additional Hours:________________________________________ @ $247.72 = $ _________________________ <br />Print Name:_____________________________________________ Signature:____________________________ <br />Representing:________________________________________________________________________________ <br />Telephone: ( )____________________________________Fax: ( ) __________________________________ <br />Contact Person: ________________________________________Telephone: ( ) ________________________ <br />E-mail (Strongly Recommended): _________________________________________________________________ <br />PLANS PREPARED BY AN ARCHITECT OR ENGINEER MUST BE SIGNED BY THE PROFESSIONAL WHO PREPARES THEM. <br />PLEASE WRITE A BRIEF DESCRIPTION OF THE REVISION/SUPPLEMENT AND IF POSSIBLE AREA OF WORK. ALL REVI- <br />SIONS ARE TO BE CLOUDED AND PROPERLY IDENTIFIED: (i.e. Deltas, Sheet Numbers, etc.). <br />Electrical, Plumbing and/or Mechanical plans – stamped job set shall accompany revised plans. <br />______________________________________________________________________________________ <br />______________________________________________________________________________________ <br />______________________________________________________________________________________ <br />______________________________________________________________________________________ <br />______________________________________________________________________________________ <br />2429 W Hall Ave <br />02/13/23