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CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT <br />PROJECT ADDRESS: <br />USE OF BUILDING: <br />3/2/05:forms/Bldg.ADP.Worksheet <br />1 2155. 2/+C PIP.V SUITE:SAPIN #10109'76913 <br />RESIDENTIAL ('-EBMIOIEp INDUSTRIAL OTHER <br />MASTERID# <br />NATURE OF WORK:) ADD ALTER/T. I.DEMO REROOF REPAIR SIGN MISC <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:SIgh.5 <br />GARAGE/CARPORT:SF ALTEFUT. I.: SF <br />JOB DESCRIPTION (non-residential projects see reverse side of this application) :b) 206" w x 3'-O"H <br />k)911 6'10n non-illumiria·+26 .) Il'-5" W K 1'-10" 11 <br />F)01/i-illu,n Wall bien. <br />BUILDING OWNER'S NAME: <br />V Dg F gal €4ate Gervt [15 <br />ADDRESS:CITY: . <br />1.01.n mal,161.3-1-1 100 I r vin b <br />PHONE NO:0148.@&1,6/00 <br />STATE:ZIP <br />CA 8 20 lu <br />TENANT'S NAME (Comm/Ind):WD Supp 4 IA) h i te Cop GILIA JOI u, 20-1.l <br />PHONE NO: <br />CONTRACTOR'S,NAME: <br />51@na@€60|Lelloni <br />ADDRESS:22315. Du pont Dr. <br />WORKERS COMP. POLICY#:EXP. PATE: <br />\NC.q[,(,0/9003 ilillu <br />ARCHITECT/ENGINEER: <br />N lit <br />ADDRESS: <br />STATE CONTR. #:LICENSE CLASS:PHONE NO: <br />0.4,57- '---4 60#8&8 7/4.49/-0249 <br />CITY: 0 STAIE:Zle <br />Anah am 019 (4280(0 <br />INSURANCE COMPANY:.SANTA ANA BUS. LlC. #: <br />Zur'lol Clmertean <br />STATE LICENSE #PHONE NO: <br />CITY:STATE:ZIP: <br />CONTACT NAME:Ona, 44[edhm PHONE NO:7/4- R/2- 765-41 <br />E-MAIL ADDRESS: <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: $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 OK TO CHECK& DATE BLDG. DEPT. APPROVAL & DATE <br />PLNG CONDITIONS: