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CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT 3/2/05:forms/Blda.App Worksheet <br />PROJECT ADDRESS: 3% 51 9. Er 13+01 S+.SUITE: SAPIN # I U)/ *(16) 9 <br />1 <br />USE OF BUILDING.RESIDENTIAL 6-€6MMERCI) INDUSTRIAL OTHER <br />MASTERID# <br />/N <br />NATURE OF WORK: LMEY-3 ADD ALTER/T.I.DEMO REROOF REPAIR GibN j MISC <br />NEW/ADDITION/ALTERATION· <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: <br />GARAGE/CARPORT:SF ALTER/T. I.:SF <br />JOB DESCRIPTION (non-residential projects see reverse side of this application): WQ\\ Sgn \n€Ao\Zo46n <br />BUILDING OWNER'S NAME:te-v ih -1-\Tl I <br />ADDRESS:2115 Preston Ra. Sut+%00 CITY <br />PHONE NO:949· 725- 2652 <br />ZIP:75229DdltasSTATE:-fi< <br />TENANT'S NAME (Comm/Ind):Park* C\4 PHONE NO Qqq - 125-3(0 51 <br />CONTRACTOR'S NAME:11\14 STATE CONTR.* 1 <br />572740 40 - 4 9 <br />LICENSE CLASS: <br />C C- 45 <br />PHONE NO: <br />7/4-241-4701 <br />ADDRESS:900 W. *<Rom Age.CITY::orangp 'CASTATE·ZIP:R&(05 <br />WORKERS COMP. POLICY#: <br />/to\62519 - 1 9 <br />EXP. DATE:INSURANCE COMPANY <br />Sink *nA <br />SANTA ANA BUS. LlC. #: <br />8'105 14 <br />ARCHITECT/ENGINEER:STATE LICENSE #:PHONE NO: <br />ADDRESS<CITY:STATE:ZiP: <br />CONTACT NAME/121 How ard PHONE NO: 7 / 9- 242- 4 70 2 <br />E-MAIL ADDRESS: -7-€A €) Leav f nc¢( our r·nal-14 .Corn <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 & DA A j ) hs--V\.00/ <br />PLNG CONDITIONS: <br />TE