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CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT 3/2/05:forms/Blda.App.Worksheet <br />PROJECT ADDRESS:21%/ ¥\L (04»ud\Vd SUITE: 6 -3 SAPIN # /0) i S Kfilc? <br />USE OF BUILDING: RESIDENTIAL/IME'NED> INDUSTRIAL OTHER <br />MASTERID# <br />NATURE OF WORK: NEW ADD ALTER/T. I. DEMO REROOF REPAIR (ISIGN') 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 ALTERrr.1.: SF <br />JOB DESCRIPTION (non-residejitial projects see reverse side of this application) :Cha,Me.1 lei-fer €19i \\u vn inal<_01 <br />BUILDING OWNER'S NAME Oarlo 0, sp«PHONENO:¥ I K · 90 7 - *?SE <br />ADDRESS:2.0 130X 2 COARD CITY:01 b.yl ££,L STA/4 1/ 11 r - <br />ZIP· n <br />TENANT'S NAME (Comm/Ind):N A-Uvil 14-Al ·fkj 449 973.0999PHONE NO' <br />CONTRACTO A LICENSE CLASS-PHONENO-Mact Cof¥*- Sir ¢45-(14131 909.919.94?f <br />ADDRESS:43(? -6 -sa,AA,4 c'© n.kin D OFI 7/76/ <br />STATE..ZIP - <br />WORKERS COMP. POLICY#:EXP. DATE·INSURANCE COMPANY:SANTA ANTit-? 3 /A 09 2 91 9 1 9 9-11jy FAI/PN,l/1- <br />ARCHITECT/EIltY: 64@- '454 - STATE LICESE #:.PHONE NO· <br />3/?u MUS '1 0 j *907 979999 9 <br />ADDRESS:1 3 \9,2 %00,4 th* 62- C744. M b STATEE,7 Z'*/7 4/ <br />CONTACT NAME:141 01 1/j 5 56< /4 rc it Cl PHONE NO:q69 919.4979 <br />E-MAIL ADDRESS: I/)\ UV'%54 £|4 acc c*-AA 9 6,4,0,1 <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 OKTO CHECK& DATE BLDG. DEPT. APPROVAL & DA-i. 33.U¥27*1 <br />PLNG CONDITIONS:Udjul.) 1 Ly-r,--==j./.'//r.'p''Erimizij-