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CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT <br />PROJECT ADDRESS: <br />USE OF BUILDING: <br />3(0 U . 1\4 42 2 22'0*SUITE: <br />RESIDENTIAL COMMERCIAL INDUSTRIAL <br />NEW/ADDITION/Al TFRATION· <br />1 ST FL.. · SF BASEMENT: YES/NO <br />2ND FL...SF PATIO/ENCL. PATIO: <br />TOTAL OF OTHER FLS:SF RES. REMODEL: <br />GARAGE/CARPORT:SF ALTER/T. I.: <br />JOB DESCRIPTION (non-residential projects see reverse side of this application) <br />D <br />OTH <br />( RE <br />SF <br />SF <br />SF <br />SF <br />3/2/05:forms/Blda.App.Worksheet <br />SAPIN # 6,=4 13 - 1 08-6,lg-- <br />/ Of-19 7 7 / <br />MASTER ID# <br />NATURE OF WORK: NEW ADD ALTER/T. I.DEMO REROOF iPAIR 3 SIGN MISC <br />NO. OF STORIES: <br />BLDG. HEIGHT: <br />PROPOSED USE: <br />BUILDING OWNER'S NAME:PHONE NO: <br />ADDRESS:CITY:·STATE:ZIP: <br />TENANT'S NAME (Comm/Ind):PHONE NO: <br />CONTRACTOR'S NAME:97 . TAG D 1 /*diff STATE CONTR.#: -LICENSE CLASS:PHONE NO: <br />9%00\% i 7/4-/9/4--6651 <br />ADDRESS: CITY:STATEJ ZIP: 1 <br />SAWORKERS COMP. POLICY#:EXP. DATE:INSURANCE COMPANY:A ANA BUS. LIC. #: <br />ARCHITECT/ENGINEER:*10*wd N I k t O 0 STATE LICENSE #:36969 PHONE NO: -+ r <br />. 1 r f. / 290.-6R c, <br />ADDRESS:CITY:,.STATS ZIP: <br />£-i <br />CONTACT NAME:PHONE NO: <br />E-MAIL ADDRESS: <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:/ -A>/ S <br />FIRE SPKR: YES / NO A/C: YES / NO FLOOD ZONE:PROCESSED---_23 <br />RES. DEV. FEE: YES / NO PRIOR DWELLING UNIT : YGS / NO COMMENTS:PLANNING OK TO CHECK & DATE'y'°Le' 4fi., 3 BLDG. DEPT. APPROVAL & DATE <br />PLNG CONDITIONS:1-o.6 I A.£. 1# 261, 3 9-