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CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT <br />PROJECT ADDRESS: 22-2,3 9, g 065 <M- , <br />USE OF BUILDING:.<333>L COMMERCIAL <br />SUITE: <br />INDUSTRIAL OTHER <br />3/2/05:forms/Blda.App.Worksheet <br />SAPIN #09 90 9 X9 <br />MASTERID# <br />NATURE OF WORK: NEW ap ALTER/El.DEMO REROOF REPAIR SIGN MISC <br />NEW/ADDITION/ALTERATION· <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 ALTER/T. 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) : RES'kE(, wit)-4 I '2) I Cl v <br /><941<N-evt/7 - /OX 92--7 4/ 2042 (No"latec,4 (PLLerize -n/ort,u' C \A,AOC.S <br />1 /9,000 <br />BUILDING OWNER'S NAME PHONE NO:41 pobts dj 124 1 7(4 -540 -013 -2- <br />ADDRESS CITY:STATE:zia <br />'1 7%7-,3 6 203% 91-<5At« Ar?A,CA 72-707 <br />TENANT'S NAME (Comm/Ind):PHONE NO: <br />CONTRACTOR'S NAME:STATE CONTR. #LICENSE CLASS PHONE NO: <br />Sun Be-es- Groor> INc-,93>05 9 J 8, 09 4-7/9-676- 9099 <br />ADDRESS:CITY:STATE:ZIP· <br />95/ GU Cottmlogy & Al 26 24 -L 44 -2 @-2-1 <br />WORKERS COMP. POLICY#:EXP. DATE: 02/ /0/9 INSURANCE COMPANY:SANTA ANA BUS. LIC. #: <br />9005 15'V -/3 051*fo Ovwpu,Tat, >Fi /,eu/c.lit FW/70<' <br />A==27=£ <br />ARCHITECT/ENGINEER:STATE LICENSE #PHONE NO:D bu.4 3 A, Mova <-65 C 69 1 6 -3 919 -149-9/04 <br />ADDRESS:CITY:STATE:ZIP: <br />/ D-L P WIOn -Tr -2,t 60 6* CA 9261-7 <br />CONTACT NAME: 1 *vlcri-6.Mot v,04.u PHONE NO: 41--6 - 9 g O -6 E--2 G <br />E-MAIL ADDRESS:1 LA chu (g) +VUL poue-tv Oblacc-· Cov'Vi <br />UU <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: $161 j (JEO 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: