Laserfiche WebLink
CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT <br />PROJECT ADDRESS:63( 41. /'All- g.luet <br />USE OF BUILDING:RESIDENTIAL *MMERt> <br />SUITE: 3 <br />INDUSTRIAL OTHER <br />3/2/05:forms/Bldg.App.Worksheet <br />SAPIN #1014599*> <br />MASTER ID# <br />/ \1 <br />NATURE OF WORK: NEW ADD ALTER/T. I.DEMO REROOF REPAIR ('SIGNj MISC <br />NEW/ADDITION/Al TFRATION· <br />1ST FL.. SF BASEMENT: YES/NO SF <br />2ND FL..SF PATIO/ENCL. PATIO:SF <br />TOTAL OF OTHER FLS:SF RES. REMODEL: SF <br />GARAGE/CARPORT SF ALTERIT.I.: SF <br />JOB DESCRIPTION (non-residential projects see reverse side of this application) : <br />NO. OF STORIES: <br />BLDG. HEIGHT: <br />PROPOSED USE: <br />BUILDING OWNER'S NAME: A A PHONE NO:K , rewel« AN&4 <br />ADDRESS:CITY1 3495- 90+ LU_ 04 1-e .Irt€00< 40R_- STAT* <br />11 .V - <br />TENANT'S NAME (Comm/Ind):P k FE- LE,k i < PECD)hi 4-PHONE N <br />626-alle-29*e <br />ZIP.4/ 7,6 <br />2.6 - 296 - as.0 <br />CONTRACTOR'S NAME:L.e*66; 6 1446 <br />ADDRESS: <br />1 7-2-Z /&<HIAL{*A &244. BW <br />WORKERS COMP. POLICY#EXP. DATE <br />ARCHITECT/ENGINEER: <br />ADDRESS <br />STATE CONTR. #LICENSE CLASS:PHONE NO: <br />%66 919 00'44 1/0 -996 -3313 <br />CITY'STAT#:7f ZIP:Ak (»E 6,1 90266 <br />INSURANCE COMPANY:SANTA ANA BUS. LlC. #: <br />STATE LICENSE#PHONE NO: <br />CITY:STATE:ZIP: <br />CONTACT NAME: 14,1 6Ls,_PHONE NO: 3 13 - 30 9 - //64- <br />E-MAIL ADDRESS: D€,0© a.40 ro 4 Lbk N ; u.c- . e-e L-1 j <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 FLOODZONE PROCESSED <br />RES. DEV. FEE: YES/NO PRIOR DWELLING UNIT: YES / NO COMMENTS: <br />PLANNING OK TO CHECK & DATE BLDG. DEPT. APPROVAL & DATE 1 <br />PLNG CONDITIONS: 1 ) c-,-1_OcrvS»·131 3-le__3