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CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT 3/2/05:forms/Blda.ADD.Worksheet <br />PROJECT ADDRESS: 14 04 -Paw.M 6-P SUITE:SAPIN #/O I 19 7 *- <br />USE OF BUILDING: <2SIDEN¥krE> COMMERCIAL INDUSTRIAL OTHER <br />MASTER ID# <br />NATURE OF WORK:NEW ADD eLTERIT.f DEMO REROOF REPAIR SIGN MISC <br />NFW/ADDITION/Al TFRATION: <br />1ST FL.. <br />2ND FL.. <br />TOTAL OF OTHER FLS: <br />GARAGE/CARPORT: <br />SF BASEMENT: YES/NO <br />SF PATIO/ENCL. PATIO: <br />SF RES. REMODEL: <br />SF ALTERIT. I.: <br />SF NO. OF STORIES: <br />SF BLDG. HEIGHT: <br />SF PROPOSED USE: <br />SF <br />JOB DESCRIPTION (non-residential projects see reverse side of this application) : yoe £ r,10£,prt-W <4ler pall,Pl)tz, Fne€lb ·3. Ok'»- <br />BUILDING OWNER'S NAME:PHONE NO: <br />T,A A 4 9- £*.4 hin <br />ADDRESS'CITY:STATE:0 1 409 -Fal,™ 5+54 PIA A k,CA <br />7/4 -74 l -305-7 <br />ZIP: <br />9 270 3 <br />TENANT'S NAME (Comm/Ind):PHONE NO: <br />CONTRACTOR'S NAME: i STATE CONTR. #:LICENSE CLASS:PHONE NO:4 0 kr· 0,+4 94<r loy Cq6 -74.1- 724-476 4 <br />ADDRESS'CITY: .STATE:ZIP:2/6 5 5 Grad Aut 5444 A «CA 92105- <br />WORKERS COMP. POLICY#: <br />764 1,06 67*tiD33 <br />EXP. DATE: <br />lic,14 <br />INSURANCE COMPANY: <br />Z. ar t Clt <br />SANTA ANA BUS. LlC. #: <br />ARCHITECT/ENGINEER:STATE LICENSE #:PHONE NO <br />Abelarl) E. De uer«09 2 202 <br />ADDRESS:CITY:STATE:ZIP: <br />CONTACT NAME:Toen,MY PAN PHONE NO: 7/4 724- 9764 v <br />D <br />E-MAIL ADDRESS: 1-a & 0,1 5) inlar C,·1-1 · Copvi 2 <br />OFFICE USE ONLY:ACC OR SPC (CIRCLE ONE)HRS PER C BMG. FEE: <br />OCC. GROUP:RECEIPT #Al A °'C FEE PD $Hvv,\JTYPE OF CONSTR:VALUATION: $12/ 000 BMITTAL 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 OK TO CHECK& DATE BLDG. DEPT. APPROVAL & DATE <br />PLNG CONDITIONS: