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CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT <br />PROJECT ADDRESS:lit Q N . MA•. 5 42 -*SE'%SUITE: 10 6 8 <br />USE OF BUILDING:RESIDENTIAL /66MMEREAA INDUSTRIAL OTHER <br />3/2/05:forms/Blda.ADD.Worksheet <br />SAPIN #l,OI -7917 L <br />MASTER ID# <br />NATURE OF WORK:NBN ADD ALTER/T. I.DEMO REROOF REPAIR 0,3 MISC <br />NEW/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 ALTER/T. I.:SF <br />JOB DESCRIPTION (non-residential projects see reverse side of this application) : <br />I//uni, p,Goted Re.ve.ng- 6.4£*MJ U:tle,rs ( l.jat/ 930,<) <br />BUILDING OWNER'S NAME:(0 <914; 0 d <br />ADDRESS1,54.9 C Of'lfJ'-y Aw< 6, 4/ , ciwj--A <br />TENANT'S NAME (Comm/Ind):809 4 ady k <br />PHONE NO: <br />315 - 5-7 Z - 62 461 <br />STATE:ZIP: <br />CA 960 67 <br />PHONE NO: <br />CONTRACTOR'S NAME: , .STATE CONTR. #:LICENSE CLASS:PHONE NO:519 nco m.1 762 40 C-45 113-339- 17 0 <br />V <br />ADDRESS:CITY:STATE:ZIP:38-4- Bwer(7 13 1.LA 90057 <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:(16/1. 5 £21 PHONE NO:113 -316-577 1 <br />E-MAIL ADDRESS: 5/4 .,comlooo Bay,600 .cOM <br />- <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: 'l F <br />FIRE SPKR: YES / NO A/C: YES / NO FLOOD ZONE:PROCESSED 96[ <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: