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CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT 3/2/05:forms/Blda.ADD.Worksheet <br />PROJECT ADDRESS:9 1 9 E<<-liiat- 3© suiTE:SAPIN #lop-19149 <br />USE OF BUILDING:RESIDENTIAL ®MMERCIAL,/ INDUSTRIAL OTHER <br />NATURE OF WO<:NEVV) <br />NFW/ADDITION/Al TFRATION <br />1ST FL.. <br />2ND FL.. <br />TOTAL·OF OTHER FLS: <br />GARAGE/CARPORT: <br />JOB DESCRIPTION (non-res <br />( 0 MW l.pi <br />MASTER ID# <br />ADD ALTER/T. I.DEMO REROOF REPAIR SIGN MISC <br />SF BASEMENT: YES/NO SF NO. OF STORIES: <br />SF PATIO/ENCL. PATIO:SF BLDG. HEIGHT: <br />SF RES. REMODEL:SF PROPOSED USE: <br />SF ALTER/T. I.:SF <br />idential projects see reverse side of this application) : <br />Uou 41 5,©_, 40 Tray ic Plure60 |ls.189 j 7 0 <br />BUILDING 0lU82j, /Abl 6 (%'r,)o.q PHONEND655 265- 19 <br />ADDRESS %905 -MIA) fle- &MidfDKI CITY- 0h STATE: /1 ZIP:20-13·8.-0 <br />TENANT'S NAME (Comm/Ind):Hard,n (1 s.PHONE NO: <br />CONTRACTOR'S NAME: B STATE CONTR #LICENSE CLASS:PHONE NO'D5 &-6-44(41%624(24 MS OIl) 761'*DO <br />ADDRESS:104* gcat,via,L- j|*-e-fila n f__ d#--- <br />CITY:STA>4 Bro cP 8-z> <br />WORKERS COMP. POLICY#: .EXP. DATE: i INSURANCE COMPANY:SANTA ANA BUS. LlC. #: <br />Cavly hop Chs.)0-«-4 /14 CPA 17045. <br />ARCHITECT/ENGINEER:STATE LICENSE #PHONE NO: <br />ADDRESS:CITY: <br />E-MAIL ADDRESS:}ind,41017 67 al. Ma'd. Abtfl <br />STATE:ZIP: <br />(91) Ms -3787CONTACT NAME:-,044 Q,thi-PHONE 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 P»«3*6\-2PLNG CONDITIpNS:q }246*64« LE-. <br />1.