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CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT -3/2/05:forms/Blda.App.Worksheet <br />PROJECTADDRESS: 12-3 W, 5 -TH ST·. 5* . SUITE:SAPIN #101 935 12>7 <br />USE OF BUILDING: 'NEEENTIAL-COMMERCIAL INDUSTRIAL OTHER <br />MASTER ID# <br />'ADDNATURE OF WORK:NEW 1 ALTEIVT.I.DEMO REROOF REPAIR SIGN MISC <br />NFW/ADDITION/Al TFRATION <br />1 ST FL..SF BASEMENT: YES/NO .SF NO. OF STORIES: <br />2ND FL..SF PATIO/ENCL. PATIO:367 SF BLDG. HEIGHT: <br />TOTAL OF OTHER FLS:SF RES. REMODEL: SF PROPOSED USE: <br />GARAGE/CARPORT:SF ALTERIT.I.: SF .,A, p F*-A-A/le <br />JOB DESCRIPTION (non-resideptial projects see reverse side of this application) : A. 9444=6*6· FA-Tro - <br />Ah>e e F--2-A M €Na P A-[ 10 <br />BUILDING OWNER'S NAME:PHONE NO:TA M U« Ove,J 7 f 94 902 -6/29 <br />ADDRESS:CITY:STATE:ZIP: <br />9123 \2 , S TH ST.5'149+EA- A- iJA C.,A-9270 1 <br />TENANT.'S NAME (Comm/Ind):PHONE NO: <br />CONTRACIOR'S NAME:STATE CONTR. #:UCENSE CLASS:PHONE NO: <br />ADDRESS:CITY:STATE:ZIP: <br />WORKERS COMP. POLICY#:EXP. DATE:INSURANCE COMPANY:SANTA ANA BUS. LIC. #: <br />ARCHITECT/ENGINEER:STATE LICENSE #:PHONE NO <br />ADDRESS:CITY:STATE:ZIP: <br />CONTACT NAME:PHONE NO: <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 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: