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CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT 3/2/05:forms/Blda:App.Worksheet <br />PROJECT ADDRESS:-2 3 02 1*_daf ' SUITE: 8 SAPIN #10/ € bka '7 <br />USE OF BUILDING:RESIDENTIAL OMMERCIA_)INDUSTRIAL OTHER <br />MASTERID# <br />NATURE OF WORK: 6EV ADD ALTER/T. I.DEMO REROOF REPAIR SIGN MISC <br />NEW/ADDITION/ALTERATION <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 ALTER/T.L SF <br />JOB DESCRIPTION (non-residential projects see reverseside of this application) : <br />BUILDING O\ANER'S NAME:ke#-) 4 k ,-9 Am-pt>j *u PHONE NO: <br />V <br />ADDRESS CITY:STATE: 60£ZIP: <br />..40 1 9-4+A 94 400. .S#-A>YA *6-AP) CA 0 r -,t- 1 044 I <br />TENANT'S NAME (Comm/Ind)PHONE NO: <br />CONTRACTOR'S NAME:74. 9 6-,u <br />ADDRESS:9 un 4-Dkk' 0(g' A 70 <br />WORKERS COMP. POLICY#:EXP. DATE: <br />STATE CONTR. # <br />16/761 <br />CITY: <br />H./014 9-y <br />INSURANCE dMPANY <br />LICENSE CLASS:PHONE NO <br />6-49 7,4 350 -«43.3 <br />STATE:ZIP: <br />0+Cll·<CO <br />SANTA ANA BUS. LlC. #. <br />ARCHITECT/ENGINEER:STATE LICENSE #:PHONE NO· <br />ADDRESS·CITY·STATE:zIp: <br />CONTACT NAME:D ()61)6 030-0/0 PHONE NO:( 7/4 ) R , 57) - n 24 9 3 <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 FLOOD ZONE: PROCESSED <br />RES. DEV. FEE: YES/NO PRIOR DWELLING UNIT : YES / NO COMMENTS: <br />PLANNINGOK TO CHECK & DATE BLDG. DEPT. APPROVAL & DATkl-flf--221PLNG CONDITIONS: <br />Atja,1)90