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CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT 3/2/05:forms/Bldg.App.Worksheet <br />PROJECT ADDRESS:8\DOM W Ro Wa-SUITE:SAPIN #1 01 9 1097 <br />USE OF BUILDING:RESIDENTIAL COMMERCIAL INDUSTRIAL OTHER <br />MASTERID# <br />NATURE OF WORK:NEW ADD ALTER/T. I.DEMO REROOF REPAIR SIGN MISC <br />NFW/ADDITION/Al 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) :598 Aw 00+mou®d &810¢g <br />M ?Mix\S j WI V«¥.0 ,#AM/#,BC, j Af&(OM\QAh (J5' ribnc\1* <br />BUILDING OWNER'S NAME:A\*Adrzo Evil <br />ADDRESS:SU04 W Re..u,ti OR CITY SAM Ana <br />TENANT'S NAME (Comm/Ind):k,jandwo 12«·z <br />.. <br />CONTRACTOR'S NAME:V\Vw\, SD\ate 003164 <br />STATE CONTR. #: <br />PHONE NO: <br />STATE: CA ZIP:42105 <br />PHONE NO: <br />LICENSE CLASS:PHONE NO: <br />CHU l!51 W Oo 225 2 <br />ADDRESS:4431 ro @00 W CITY:fybvo STATE: LJT 614V0LIZIP <br />WORKERS COMP. POLICY#:EXP. DATE:INSURANCE COMPANY SANTA ANA BUS. LlC. #: <br />i 0193(A Z.S-KLA i\)1 liu Al A Cloums ln(· <br />ARCHITECT/ENGINEER:STATE LICENSE #:PHONE NO: <br />ADDRESS:CITY:STATE:ZIP: <br />CONTACT NAME:AM,\<S561 ?FAnt-t PHONE NO:U51190082,61 <br />E-MAIL ADDRESS:ae(AM€ ro\)*990\(W-G \Jiv\Wr. ¢M\/\ <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: $\11 508.00 SUBMI-r-1-AL DATE: C-1-1 63 )4 <br />FIRE SPKR: YES / NO A/C: YES / NO FLOOD ZONE:PROCESSED .Yl <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: