Laserfiche WebLink
CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT 3/2/05:forms/Blda.App.Worksheet <br />PROJECT ADDRESS:n-1 9 06nm' f St SUITE:SAPIN #toi €10902 <br />USE OF BUILDING:RESIDENTIAL -COMMERCIAL INDUSTRIAL OTHER <br />MASTERID# <br />NATURE OFWORK: NEW ADD ALTERIT. I.DEMO REROOF REPAIR SIGN MISC <br />NEW/ADIDITION/ALTERATION· <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 (non-residential projects see reverse side of this application) :5 K\N 2666--1¥YNAA+<61 <6161% <br />'10 ?OAA,6, 10 ™C)¢.6 -\nOR]00f \ rAnt\, 1 5&(D Melk j \Ur ewid¥- <br />BUILDING OWNER'S NAME:WWMh 'MOUS PHONE NO: <br />ADDRESS:tla € Omn€ St- <br />TENANT'S NAME (Comm/Ind) <br />CONTRACTOR'S NAME:\frvint Sagrk <br />ADDRESS:11 961 9 500 \14 <br />WORKERS COMP. POLICY#:EXP. DATE <br />\Nt 029 8413 14 il/\ (ILA <br />ARCHITECT/ENGINEER: <br />ADDRESS: <br />CONTACT NAME:WA\ES( Ae-lnlf <br />CITY:Santa Anc\STATE: C,A. ZIP:quO5 <br />PHONE NO: <br />STATE CONTR, #:LICENSE CLASS:PHONE NO: <br />011315u CUiD \6-ll¥]6K251- <br />CITY:&040 STATE: 1 M-ZIP:FLAUM <br />INSURANCE COMPANY:SANTA ANA BUS. LIC. # <br />A\G, t.laiwd HU, <br />STATE LICENSE #:PHONE NO: <br />CITY:STATE:ZIP: <br />PHONE NO: (06-1 · OOD· 7252 <br />r <br />E-MAIL ADDRESS:(32.angE r ax\Hy*\11*03 V\Vm¥, Con-b <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: $ 5, 6®. 0 0 SUBMITTAL DATE:4-\6>-) 4 <br />FIRE SPKR: YES / NO A/C: YES / NO FLOOD ZONE PROCESSED r- 1'5 <br />RES. DEV. FEE: YES / NO PRIOR DWELLING UNIT: YES / NO COMMENTS: <br />PLANNING OKTOCHECK& DATE -BLDG. DEPT. APPROVAL & DATE <br />PLNG CONDITIONS: <br />4 m