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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:2%00 1616 Mak 54 SUITE @47 SAPIN# tolrl 99(g <br />USE OF BUILDING:RESIDENTIAL 4*#egiL INDUSTRIAL OTHER <br />MASTERID# <br />NATURE OF WORK:NEW 'ADD ALTEFVT. I.DEMO REROOF REPAIR MISC <br />NFW/ADDITION/Al TFRATION· <br />1ST Il.. Gr 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.1.SF <br />JOB DESCRIPTION (non-residential projects see reverse side of this application): #5(A\\ 0*<L -6\\0•hivwkl <br />9/k <br />BUILDING OWNER'S NAME:PHONE NO: <br />ADDRESS:CITY:STATE:ZIP: <br />TENANT'S NAME (Comm/Ind):PHONE NO: <br />CONTRACTOR'S NAME21 STATE CONTR. #:LICENSE CLASS:PHONE NO:DU)0\91 33251 \ v\C C45 909-4(00-2530 <br />ADDRESS:CITY:STATE'ZIP:j I*\ 9. M \A 9-06660 CA 91-7 00 <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: ) C 552(CL PHONE NO:909-7,6 - qG o--2530 <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 <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 CONDITI <br />IX <br />pNS: