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CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT <br />PROJECT ADDRESS:2,2 14 K. 8,Ft 31-d 4 k__ SUITE: M <br />USE OF BUILDING:RESIDENTIAL COMMERCIAL INDUSTRIAL OTHER <br />3/2/05:forms/Bldg.App.Worksheet <br />SAPIN # .O legaft-63 <br />MASTER ID# <br />NATURE OF WORK:NEW ADD '.ALTERIT. 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:SF BLDG. HEIGHT: <br />TOTAL OF OTHER FLS: SF RES. REMODEL:SF PROPOSED USE: <br />GARAGE/CARPORT: SF ALTERIT.1.SF <br />JOB DESCRIPTION (non-residential projects see reverse side of this application) : <br />Th\*1/h&49 il(ltkin,rlyrl cL --1/ Il) 41. I 3 1 9 11irc <br />BUILDING OWNER'S NAME:Susan L' 04 PHONE NO:944.-160-23.9/ <br />1 Vt v <br />ADDRESS: .CITY:STATE:ZIP: <br />TENANT'S NAME (Comm/Ind): ,PHONE NO: 1 14 - 3.%31 2225*ev -3 - c i OM M <br />CONTRACTOR'S NAME:STATE CONTR. #:LICENSE CLASS:PH NE NO:Sur. (es 5 9) @ar 2,9 ME* p C r- 624¥«}Y / <br />ADDRESS'CITY:STATE:ZIP2312- @rk tad -9 ivioute C A-4(131 <br />WORKERS COMP. POLICY#:EXP. DATE: ,INSURANCE COMPANY:SANTA ANA BUS. LIC. #: <br />191 0 1 05--04/04 / ¢ slatE 4 ™3 . <br />ARCHITECT/ENGINEER:STATE LICENSEE #: £1 PHONE NC-6 - -r- <br />ADDRESS:CITY:STATE:ZIP: <br />.,5 <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'1*Y»63%2--23 <br />PLNG CONDIiTIONS <br />8 1\ A <EL*==-=blyte.4 L j 24 11 g¥ L:492*21