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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: 176/ E do,pry-Are SUITE:SAPIN #.01 rig 69 91 <br />;IAUSE OF BUILDING:RESIDENTIAL COMMERC INDUSTRIAL OTHER <br />NATURE OF WORK:NEW ADD <br />NFW/ADDITION/Al TFRATION· <br />1ST FL.. <br />2ND FL.. <br />TOTAL OF OTHER FLS: <br />GARAGE/CARPORT: <br />JOB DESCRIPTION (non-residential <br />1 (INN/Aa Pcl W <br />ALTER/T. I.DEMO REROOF <br />SF BASEMENT: YES/NO <br />SF PATIO/ENCL. PATIO: <br />SF RES. REMODEL: <br />SF ALTERIT. I. <br />proj?cts see reverse side of this application) <br />A l j S /34 <br />MASTERID# <br />SF NO. OF STORIES: <br />SF BLDG. HEIGHT: <br />SF PROPOSED USE: <br />SF <br />Ont %O n 04 <br />REPAIR MISC <br />BUILDING OWNER'S NAME:Potoific Wef/¥501 th'«) 1- <br />ADDRESS:314 1 -P A-1 rport Loop C-04&& MSACITY: <br />TENANT'S NAME (Comm/Ind): Rh 1r02UfF Er i neert nj <br />CONTRACTOR'S NAME: -STATE CONTR. #:rro mo bonot 1 6/9ns 6365/2 <br />ADDRESS CITY: <br />5301 9. 9149 el, 9-5 RA )0\,xe <br />WORKERS COMP. POLICY#EXP. DATE INSURANCE COMPANY: <br />-090 %0 itt 00>4/ ' 1/4 Ap lorer- <br />PHONE NO-714 438 -7300 <br />STATE:,ZIP: <br />L71 92616 <br />PHONE NO·949 754 9050 <br />LICENSE CLASS:PHONE NO: <br />045 -11&\ 9*9Fb'-1 <br />STATr Z'6&*« <br />SANTA ANA BUS. LIC. #: <br />/66'782 <br />ARCHITECT/ENGINEER:STATE LICENSE #:PHONE NO: <br />ADDRESS:CITY:STATE:ZIP: <br />CONTACT NAME:600 + 010»he PHONE NO:-11 9 9+0 9+54 <br />E-MAIL ADDRESS:Se,hri S -16 e_ yorIDS,/15, cO/'07 <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 & DATB Vi <br />PLNG CONDITIONS: <br />0\-Ll-)6 <br />r <br />t