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CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT <br />PROJECT ADDRESS:A94 9 etumk£<2 <br />USE OF BUIEDING RESIDENT COMMERCIAL <br />SUITE <br />INDUSTRIAL OTHER <br />3/2/05:forms/Bldg.ADD.Uorksheet <br />SAPIN #la 1 9 1.02 6 <br />MASTER ID# <br />NATURE OF WORK: NEW ADD ALTER/T.I.DEMO REROOF REPAIR SIGN MISC <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 Fla 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): 4.2% KAN Koof-rnow*yA &*11% <br />\1 DON\elf b n ng<.20-*Wl¢41/@A, ) disfonnoci-5 18' Calviv#+ <br />BUILDING OWNER'S NAME:DAUM RoaM PHONE NO: <br />ADDRESS:0\34 S FM\WR. CITY.Santa PAA STATE. CA ZIP: q71 95 <br />TENANT'S NAME (Comm/Ind)thuM RocAM PHONE NO: <br />CONTRACTOR'S NAME:VWME €O\01 STATE CONTR. #LICENSE CLASS:PHONE NO: <br />91215\0 Culo l*lw oor2%2 <br />ADDRESS:44&, N 806 \Al CITY· n-STATE: UT ZIP: CLIUOLIrwow D <br />WORKERS COMP. POLICY#:EXP DATE·INSURANCE COMPANY:SANTA ANA BUS. LlC. it <br />\AC 028342824 1\/2/04 4461 a mwu )n C <br />ARCHITECT/ENGINEER:STATE LICENSE #:PHONE NO: <br />ADDRESS:CITY:STATE:ZIP: <br />CONTACT NAME:hA€\\5€64 Atl¢\(3 PHONE NO: 861 lp® 725 2 <br />E-MAIL.ADDRESS: dA(\Oje (0\NV&(h\£10--91Vt/\Vvh(NnA <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: $11 , 150.00 SUBMITTAL DAT€ l 1-6 )) L.-1 <br />FIRE SPKR: YES / NO A/C: YES/NO FLOOD ZONE:PROCESSED e\ N-f <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: