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CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT <br />PROJECT ADDRESS:61(01 N.geaa,62- gy-SUITE: <br />USE OF BUILDING:CRESIDENTIAL COMMERCIAL INDUSTRIAL OTHER <br />3/2/05:forms/Blda.App.Worksheet <br />SAPIN #)0 IN 799; <br />MASTER ID# <br />NATURE OF WORK:NEW ADE,7 ALTERIT. 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:-10 SF BLDG. HEIGHT: <br />TOTAL OF OTHER FLS: SF RES. REMODEL:SF PROPOSED USE: <br />GARAGE/CARPORT:SF ALTERIT. I.SF <br />JOB DESCRIPTION (non-residential projects see reverse side of this application) : <br />BUILDING OWNER'S NAME:5, M. PIALo NE PH.81 9 72 //9-1 <br />ADDRESS:14 0 1 b) 6 G'ketee te·E gr CITEn_,1 1-8 /1-Al 3-STATE:0#4 ZIPq=-70/6 <br />TENANT'S NAME (Comm/Ind):PHONE NO: <br />CONTRACTOR'S NAME:STATE CONTR. #:LICENSE CLASS:PHONE NO: <br />ADDRESS:CITY:STATE:ZIP: <br />WORKERS COMP. POLICY#:EXP. DATE:INSURANCE COMPANY:SANTAANA BUS. LlC. #: 1 <br />ARCHITECT/ENGINEER:STATE LICENSE #:PHONE NO: * <br />ADDRESS:CITY:STATE:ZIP: <br />CONTACT NAME:,5>t-PHONE NO: 7/9 7-72- 1/6(-51/ .01,"Dr (|1 GNL.-- <br />' <br />E-MAIL ADDRESS:5-ta 01&' i ae,rna- o# a-*2- Tcuu' ret-r,n0 <br />OFFICE USE ONLY:ACC OR SPC (CIRCLE ONE)HRS PER BLDG. FEE $ <br />OCC. GROUP:RECEIPT#G ©7 s j P/C FEE PD $ !OF go <br />TYPE OF CONSTR:VALUATION:. $33/ Scp 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 <br />PLNG CONDITIONS: <br />Glu <br />141