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CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT 3/2/05:forms/Bldg.App.Worksheet <br />PROJECT ADDRESS:\\0-5 C_20 r i \\ 0-2,\4 -Dr.SUITE:SAPIN #l.017?3 5-r <br />USE OF BUILDING:ESIBENIIALD COMMERCIAL INDUSTRIAL OTHER <br />MASTERID# <br />NATURE OF WORK:NEW ADD ALTER/T.I.DEMO REROOF REPAIR SIGN MISC <br />NFW/ADDITION/Al TFRATION <br />1ST FL.SF BASEMENT. YES/NO <br />2ND FL..SF <g*EiEIGi22) <br />TOTAL OF OTHER FLS: SF RES. REMODEL: <br />GARAGE/CARPORT: SF ALTER/T.1.: <br />SF NO. OF STORIES: <br />-518 SF BLDG. HEIGHT: <br />SF PROPOSED USE: <br />SF <br />JOB DESCRIPTION (non-residentiaprojects see reverse side qf this application) :rz *slhot, L.444(e I Munaw®04) i:=»AR o C ou-¢--- <br />BUILDING OWNER'S NAME: PHONE NO-x, \\Ono <I o (1 14) 839 -ls-8€- <br />ADDRESS:\\0 3 (LAo 0 94< 4 -Or. %21%Q 4,4 STATE:r ZIP:9170 1UX <br />TENANT'S NAME (Comm/Ind):PHONE NO: <br />CONTRACTOR'S NAME:STATE CONTR. #:LICENSE CLASS:PHONE NO'¢-DC" N CowCrs S\7 9 19- 8 C -lal)-18/-9lg9< <br />ADDRESS'CITY: i STATE:ZIP840 5. 9-eclvedpr k..e/YL O«.-bri o Ca 91-1,41 <br />WORKERS COMP. POLICY#: <br />/13SFO-600369- o fr <br />ARCHITECT/ENGINEER: <br />EXP. PATE:Ul'Lf pw INSURANCE COMPANY: <br />-m,CLAD art, <br />STATE LICENSE # <br />SANTA ANA BUS. LIC. #: <br />211 1 <br />PHONE NO <br />ADDRESS:CITY:STATE:ZIP: <br />CONTACT NAME:(»9069 PHONE NO:(98) 161-969/ <br />E-MAIL ADDRESS: C.C.«\koev-1 (P/Coer*S ko C-03-4#b. C.cirn <br />OFFICE USE ONLY:ACC OR SPC (CIRCLE ONE)HRS PER BLDG. FEE $ <br />OCC. GROUP:RECEIPT #6 100 >P/C FEE PD $ <br />la# 77 <br />TYPE OF CONSTR:VALUATION: $3100 <br />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 />144