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CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT 3/2/05:forms/Blda.App.Worksheet <br />PROJECTADDRESS: 52.1 141 1-1 -14 54 SUITE:SAP\N# )O 1 9{-3. 6 <br />USE OF BUILDING:RESIDENTIAL COMMERC INDUSTRIAL OTHER <br />MASTER ID# <br />NATURE OF WORK· NEW ADD ALTER/T.I.DEMO REROOF REPAIR 'SlaN.-/ MISC <br />NFW/ADDITION/AI 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: <br />GARAGE/CARPORT: SF ALTER/T.I.SF <br />JOB DESCRIPTION (non-residential projects see reverse side of this application) : <br />BUILDING OWNER'S NAME:U.kncti R PHONE NO: <br />ADDRESS:62\ G) 17 -th 5\-CWY STATE:/4 ZIP·7 tg* A-na (A 1 222 fl <br />TENANT'S NAME (Comm/Ind): \WMA 04,Ard5 /**FF PHONE NO: <br />CONTRACTOR'S NAME:STATE CONTR..#LICENSE CLASS.PHONE NO:1,04 51rl U &74*xy O-45 <br />UADDRESS:OTYlirtro (91 Zil76£1STATE /7 ZIP:1 331 £ 5-+St <br />WORKERS COMP. POLICY#: <br />6)&206. 6 17 o \ <br />ARCHITECT/ENGINEER: <br />EXP. DATE: <br />10/1/14 <br />INSURANCEBOMPANYfRe_knqv; Ini co <br />STATE LICENSE #: <br />SANTA ANA BUS. LlC. #: <br />PHONE NO: <br />ADDRESS:CITY:STATE:ZIP: <br />CONTACT NAME:r (259 [Ax fiM€FE-z-PHONE NO:909 460 253 D <br />E-MAIL ADDRESS: .6 \CCEN (I S £13¤IGh-Shc, A.(Dth <br />--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: $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 - \ -I.-- <br />1 1-NkbC-% <br />PLNG CONDITIONS: -\/\1 1 <br />j 01 67< l LU ILT