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CITY OF SANTA ANA (LUN ,-CLOr <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT 3/2/05:forms/Bldg.ADD.Worksheet <br />PROJECT ADDRESS: 2606 -p< 00(a, 57-SUITE:SAPIN # <br />USE OF BUILDING: Fletj>L COMMERCIAL INDUSTRIAL OTHER <br />MASTERID# <br />NATURE OF WORK:NEW ADD ALTER/T.I.DEMO 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 sjde of this application) : <br />10 *ft3O W A°of u.untt W PV Me<15 <br />BUILDING OWNER'S NAME:Ad b 1 6 G u L 714- 7444 -/b-73 <br />PHONE NO: <br />ADDRESS:CITY:STATE:ZIP*1 6 04 -Deodcv 51 fib. AUL*CA 921/0-5- <br />TENANT'S NAME (Comm/Ind):PHONE NO <br />CONTRACTOR'S NAME:STATE CONTR. #:LICENSE CLASS:PHONE NO: <br />gum 'Bels Crours Int 970 se/8 , C 46 7tq -67£ - 962 R <br />ADDRESS CITY:STATE:ZIP:451 w Lo,,lotvt 124 . Sle 2/15 45vca-CA 927 1 c <br />WORKERS COMP. POLICY#:EXP. DATE:INSURANCE COMPANY:SANTA ANA BUS. LIC. #: <br />/0/4'V) 7P1'101 2-500 i Dl / 2- 42 /14/5 5/e:·*t 1,&41 0»," <br />ARCHITECT/ENGINEER: <br />Faul €0 ), WAVirk I ./) C <br />ADDRESS: <br />n-0 l ju . 7-us-bi 14 466 <br />CONTACT NAME: ClaGctinD CA») <br />E-MAIL ADDRESS: /4 (An u., A <br />JO <br />STATE LICENSE #:PHONE NO: <br />C. CZ 65 G 7£2 - 6-30 - 6254 <br />CITY-STATE:ZIP.Ah CLU*'t InA CA 91407 <br />PHONE No: &36 -3 90-699 4 <br />+vue,powevoblov . cov,n <br />OFFICE USE ONLY:ACC OR SPC (CIRCLE ONE)HRS PER BLDG. FEE $ <br />OCC. GROUP:RECEI07#P/C FEE PD $,t <br />TYPE OF CONSTR:VALUATION: $6 5°0 suBMITTAL DT \913 L <br /> FIRE SPKR: YES / NO A/C: YES / NO FLOOD ZONE:PROCESS€6 <br />RES. DEV. FEE: YES / NO PRIOR DWELLING UNIT: YES / NO COMMENTS:KIX <br />PLANNING OKTO CHECK& DATE BLDG. DEPT. APPROVAL & DATE <br />PLNG CONDITIONS: <br />A