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CITY OF SANTA ANA tn \ 11 64 %< 4 2 <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT <br />PROJECT ADDRESS:1:Pi) C l» 9 9*SUITE: <br />USE OF BUILDING:RESIDENTIAL COMMERCIAL INDUSTRIAL OTHER <br />3/2/05:forms/Bldg.App.Worksheet <br />SAPIN # <br />MASTERID# <br />NATURE OF WORK:NEW ADD ALTERIT.I.DEMO REROOF REPAIR SIGN <br />NFW/ADDITION/Al TFRATION· <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.1. <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) :3.2-7 Hw pk s*ef:009@ M b (/tvl-17 <br />1 <br />BUILDING OWNER'S NAME:PHONE NO: <br />ADDRESS:723 D C.044€* St 777Djo <br />CITY:s £?044 /1 STATE: C ZIpty <br />TENANT'S NAME (Comm/Ind):PHONE NO: <br />CONTRACTORE NAME: elr<Ln fbutru, ·STATE CONTR. #LICENSE CLASS: <br />5- bil A+#•96=04 8 61-20 6'93*kqqa <br />ADDRESS:*PI leq-1 Hl,yl, 20 h.,3+ #2 CITY:VA M 10 UY-5 STATE: ZIP: 1 C (-(b (£,5#e q g , VBVI P lAy y z:*Cfc <br />WORKERS COMP. POLICY#:EXP. DATE:INSURANCE COMPANY: .SANTA ANA BUS. LIC. #:9 0403-7 2 -16(4 4-23 /16 Sk Le- ¥U, O <br />ARCHITECT/ENGINEER:STATE LICENSE #:PHONE NO: <br />ADDRESS:CITY:STATE:ZIP: <br />-7. <br />1*iRUENAE=*Jtple.-9*1&17 N 4 1 1<?Arod-*H0NE1No:EMR 39 4 2-4 4 g <br />-E-MAIL-ADDRESS,-----*7 A.€/.2 SD l/1 Fa,17) i t-1-lue//71 61 f ' COMA, <br />OFFICE USE ONLY:ACC OR SPC (CIRCLE ONE)HRS PER BLDG. FEE $ <br />U- ill-- - .-. <br />OCC. GROUP:RECEIPT #: - P/C FEE PD $ <br />TYPE OF CONSTR:VALUATION: $ -SUBMITTAL D< < < <br />FIRE SPKR: YES / NO A/C: YES / NO FLOOD ZONE:PROCES 0 4/ <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: <br />1 i 6-7 r