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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: \41\ W. M R.A¢EIB€* BLVD SUITE: Gl SAPIN # <br />\ <br />USE OF BUILDING:RESIDENTIAL (COMMERCIALJ INDUSTRIAL OTHER <br />MASTER ID# <br />4 DEMONATURE OF WORK: NEW ADD (ALTEF 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/ENCL. PATIO:SF BLDG. HEIGHT: <br />TOTAL OF OTHER FLS: SF RES. REMODEL:SF PROPOSED USE: <br />GARAGE/CARPORT: SF ALTERIT. I.SF <br />JOB DESCRIPTION (non-residential projects see reverse side of this application) : ift»O MO N 1 l-1-1) MI U /fl--1 <br />NO A E Le Or" c A L ) <br />BUILDING OWNER'S NAME: 'PHONE NO:7 14 433.73 30M 1-1 LOT-- 6 /7 / Ll- C <br />ADDRESS:81 8 1 - .13 Al f-f>6 Arriggp c.0 STA M € 5 A CA-GILL 2,6 <br />CITY:STATE:ZIP: <br />TENANT'S NAME (Comm/Ind):A-[FE 6-'5 9 *-c *2 f L.(PHONE NO 7 1 4 75-6 I (O-7 <br />CONTRACTOR'S NAME: .' 5'124/Ek ..STATE CONTR. #: -LICENSE CLASS:PHONE NO <br />'6 54&0 C4E -kilt-tr.-37/01- <br />ADDRESS: ·CITY:STATE ZIP: <br />l 0-7751.-611/ 7*t AVE- * 74-9 An/7€F *UVt -85 A 9294£_ <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:L 1 1011 N (ruHf-FJ PHONE NO:714 756· 1477 <br />E-MAIL ADDRESS: LI K.)b- , N 6,-0 M,Ee<3 52 12-*ITI--ELL,= 9 KC · C-0 1a <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 FLOODZONE: . 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 />9