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CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT 3/2/05:forms/Bldg.App.Worksheet <br />PROJECT ADDRESS:.2 9 0 0 /67 , /(4 4, 0 91. SUITE: 572 SAPIN #/01% 00 35-- <br />USE OF BUILDING:RESIDENTIAL COMMERS!81-INDUSTRIAL OTHER <br />V MASTER ID# <br />NATURE OF WORK: NEW ADD ALTER/T.I.DEMO REROOF REPAIR 0IG) MISC z <br />NFW/ADDITION/Al TFRATION· <br />1 ST 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 ALTEFUT.I.SF <br />JOB DESCRIPTION (non-residential projects see reverse side of this application) : <br />BUILDING OWNER'S NAME: 2 Il/jet i e- <br />ADDRESS:CITY:2049 64.Unl Park flqt· 41 5&/Aor CenturM 01 4 <br />V <br />PHONE NO: <br />(310) 699 - 5474 <br />STATE:ZIP: <br />CA-900 67 <br />TENANT'S NAME (Comm/Ind):PHONE NO:R 0% . * 4247 2 34 - 7/9 <br />CONTRACTOR'S NAME: r-,STATE CONTR. #:LICENSE CLASS:PHONE NO: <br />b i er rd:% 9 /9 n.9 939 5 9 4,C- 4 6 626)401 -2547 <br />ADDRESS:CITY STATE:ZIP:/9 3 0 A./. 2 oser".eqi 8\,4 5 . €l A 00 fe 2-A-9/733 <br />WORKERS COMP.POLICY10 7036,1 EXP DATE INSURANCE COMPANY:SANTA ANA BUS. LlC. #: <br />stqte Compe,3 44,'o n 9/4 //q Stte Con,p. 345, Av,vt <br />ih€V<Q.,e€ F unck- <br />ARCHITECT/ENGINEER:STATE LICENSE #:PHONE NO: <br />ADDRESS:CITY:STATE:ZIP: <br />CONTACT NAME: <br />E-MAIL ADDRESS: <br />(fe, C ; c 6 1. er ©a PHONE NO:(-624)401-2544 <br />a' -f Skf,ra-9 399\.<U@ MQLR O r C.e Vt/1 <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: $ c-O 0 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 />cOND'JIONS- <br />u.j---t=ef#EE-- <br />PL <br />0 <br />..r