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CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT <br />PROJECT ADDRESS: - 6 19•Ovs t\ r SUITE: <br />USE OF BUILDING: CNESIDENTIgb COMMERCIAL INDUSTRIAL OTHER <br />3/2/05:forms/Bldg.ADD.Worksheet <br />SAPIN #./O/99 7 9/ <br />MASTER ID# <br />NATURE OF WORK:ADD ALTER/T. I.DEMO REROOF REPAIR SIGN MISC <br />NFW/ADDITION/Al TFRATION· <br />1ST FL.. SF BASEMENT: YES/NO SF NO. OF STORIES: <br />2ND FL.. SF PATIO/ENet-PA¥10: 2_50.- 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) :PAT,3 Over <br />-Ifte m. O 22 01 \ 9- <br />BUILDING OWNER'S NAME:9:PHONE NO\D Avi KJ) 9.RO1«-2_719-343-82(flt <br />ADDRESS:93 3, K ; 1 s o A CITY:SA STATQ 1 270)ZIP' <br />TENANT'S NAME (Comm/Ind):PHONE NO: <br />CONTRACTOR'S NAME:STATE CONTR. #:LICENSE CLASS:PHONE NO: <br />ADDRESS:CITY:STATE:ZIP: <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: \43'Vir) 5,«cwn._PHONE NO: * / 0/- DEf 3 -0244 <br />E-MAIL ADDRESS: <br />OFFICE USE ONLY:ACC Olit5!CIRCLE ONE)HRS PER <FF BLDG. FEE $ <br />OCC. GROUP:RECEIPT #61*(0 P/C FEE PD$Elli L-/9 <br />00 <br />TYPE OF CONSTR:VALUATION: $ g2\ On---SUBMITTAL DATE:10 -8-1-=4 <br />FIRE SPKR: YES / NO A/C: YES/NO FLOOD ZONE:PROCESSED-%*33 KIL <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: