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1 0.,t- ,CITY OF SANTA ANA \4 3\ AC L.122% <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT <br />PROJECT ADDRESS: 9%19 Nlogewee,·I>og AUF , <br />USE OF BUILDING: (NESIDENTIA3 COMMERCIAL <br />SUITE: <br />INDUSTRIAL OTHER <br />3/2/05:forms/Blda.ADD.Worksheet <br />SAPIN # <br />MASTERID# <br />NATURE OF WORK: NEW ADD ALTER/T.I.DEMO REROOF REPAIR SIGN MISC <br />NFW/ADDITION/Al TFRATION· <br />1ST FL.. <br />2ND FL.. <br />TOTAL OF OTHER FLS: <br />GARAGE/CARPORT: <br />SF BASEMENT: YES/NO <br />SF PATIO/ENCL. PATIO: <br />SF RES. REMODEL: <br />SF ALTER/T. I. <br />SF NO. OF STORIES: <br />SF BLDG. HEIGHT: <br />SF PROPOSED USE: <br />SF <br />JOB DESCRIPTION (nog-residential projects see reverse side of this application): 4.2-6 b<L> 17 40 0 u 49.5 1 <br />i Tr)'Je £,UU:- / 9-0...r AA-,0 -i C PAP EL U PooAD e <br />BUILDING OWNER'S NAME:PHONE NO:SABA# CrD- 6/ <br />ADDRESS:CITY:STATE:ZIP: <br />9%;9 Nleeps,oc.spo a. Ave.GA,vt# AMN 64 9 27 D-i> <br />TENANT'S NAME (Comm/ind)PHONE NO:S FrM W Go 6-0 0,0 (7 19) 056 -1 lel- <br />CONTRACTOR'S NAME:STATE CONTR. #:LICENSE CLASS:PHONE NO: <br />SAAAIW ei,EA=Y USA 992-32-9 C96 (990707-43# <br />ADDRESS:CITY:STATE:ZIP: <br />2- ho B. S 'kna- A Al/C ,Cg> a-UNA 04 914 Yo <br />WORKERS COMP. POLICY#: <br />9023.5 7/ <br />EXP. DATE: <br />9/1 /1 4 <br />INSURANCE COMPANY: <br />g·1*ri FU r.· 0 <br />SANTA ANA BUS. LlC. #: <br />ARCHITECT/ENGINEER:STATE LICENSE #:PHONE NO: <br />ADDRESS:CITY:STATE:ZIP: <br />CONTACT NAME: 6,4 B €6-44 lOs--v=#hv-3 , PHONE NO:(9513 -707 - 49 1 0 <br />E-MAIL ADDRESS: Alot,ic.A , 5€-US<11<2) C)MA,{ ·ron <br />OFFICE USE ONLY:ACC OR SPC (CIRCLE ONE)HRS PER <br />OCC. GROUP:RECEIPT#- <br />TYPE OF CONSTR:VALUATION: $ 9-1 0-0 <br />FIRE SPKR: YES / NO A/C: YES / NO FLOOD ZONE: <br />RES. DEV. FEE: YES/NO PRIOR DWELLING UNIT: YES / NO COMMENTS: <br />PLANNING OK TO CHECK & DATE BLDG. DEPT. APP <br />PLNG CONDITIONS: <br />BLDG. FEE $ _ <br />_ P/C FEE PD $c . :,\SUBMITTAL DAT <br />fr <br />PROCE SSED«-11\ <br />.1