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CITY OF SANTA ANA <br />BUILDING PERMIT WORKSHEET <br />PLEASE PRINT <br />PROJECTADDRESS: 13>01 5. luain 9-1- <br />USE OF BUILDING:RESIDENTIAL €REERL <br />SUITE: <br />INDUSTRIAL OTHER <br />1/14/09:forms/Bldg.App.Wofksheet <br />SAPIN #1 0 1 f.1 9 9 04 <br />1 ° 13 - 10 0 1 6- 1- <br />MASTERID# <br />NATURE OF WORK: () ADD ALTER/T. I. DEMO REROOF REPAIR €§i-3 MISC <br />NEW/ADDITION/ALTERATION: <br />1STFL.. <br />2ND FL.. <br />TOTAL OF OTHER FLS: <br />GARAGE/CARPORT: <br />JOB DESCRIPTION (non-resi*r <br />1 Vulll g 1 · <br />SF BASEMENT: YES/NO <br />SF PATIO/ENCL. RATIO: <br />SF RES. REMODEL: <br />SF ALTER/T. I.: <br />itial projects seereverse side of this applicatjon) : <br />rc 419-66 2 K t< +, 0& <br />j <br />SF NO. OF STORIES: <br />SF BLDG. HEIGHT: <br />SF PROPOSED USE: <br />SF <br />41&-\1 *In-'de-A 1744-ers <br />Fo 'f CON Actrq \I c 64% n <br />BUILDING OWNER'S NAME:PHONE NO: <br />ADDRESS:CITY:STATE:ZIP: <br />TENANTS NAME (Comm/Ind)PHONE NO: <br />1 544 a lonz.ele-z_CUM) €36 -250 7 <br />CONTRACTOR'S NAME:STATE CONTR. #:LICENSE CLASS:PHONE NO: <br />M \{Ar.9,1 012 00-,ill- <br />ADDRESS:CITY:STATE:ZIP; <br />94© 11 - IUQi A St.62,4 r\,9 e-43-/4 92 2-4 <br />WORKERS COMP. POLICY#:EXP. DATE:INSURANCE COMPANY:SANTA ANA BUS. LlC. #: <br />ARCHITECT/ENGINEER:STATE LICENSE #:PHONE NO: <br />ADDRESS:CITY:STATE:ZIP: <br />CONTACT NAME:PHONE NO: <br />E-MAIL ADDRESS:FAX NO: <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 OK TO CHECK & DATE BLDG. DEPT. APPROVAL & DATE '1 14 01192\-2PLNG CONDITIONS:u ing---ts