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CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT <br />PROJECT ADDRESS'. 22-/61 ·.se/>su/,44622 6 7-SUITE: <br />USE OF BUILDING: <M COMMERCIAL INDUSTRIAL-OTHER <br />3/2/05-forms/Bldg.App.Worksheet <br />SAPIN #10 1 57/29; <br />MASTERID# <br />NATURE OF WORK NEW ADD ALTER/T. I.DEMO REROOF REPAIR SIGN C€ip> <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.L: SF <br />JOB DESCRIPTION (non-residential projects see reverse side of this application) : <br />/\j £01.-AA. /«%74 005>774) nOOF t4849 1- '6 /6448-66 <br />60 ·On. Lo.<74©863 * w <br />BUILDING OWNER'S NAME:PHONE NO: <br />/563/65.520./ ./933*ma'tifte292-(564) 2-52-- 2-7 €7 <br />ADDRESS:CITY:STATE <)ZIP: <br />Ez-L t O S Pr AiUR kin '17--066/59- '06/77 12-7/)6 <br />TENANT'S NAME (Comm/Ind)PHONE NO: <br />CONTRACTOR'S NAME: <br />la/LO GUE m.-4 v <br />STATE CONTR. #: <br />9S 39)7 <br />LICENSE CLASS:PHONE NO <br />-7 944 17/-15 50 <br />ADDRESS:CITY STATE:ZIP: <br />1 0 6.06 19(RE /1/14*24-s MTF} F- G 1, p n-f ,/4 c 44 90 407 0 <br />i <br />WORKERS COMP. POLICY#:EXP. DATE:INSURANCE COMPANY: ' SANTA ANA BUS. LIC. #: <br />ARCHITECT/ENGINEER:STATE LICENSE#: <br />99-39/7 <br />PHONE NO: <br />e (/9 -) 3, 7/ g. C o <br />ADDRESS:CITY:STATE:ZIP: <br />CONTACTNAME·. 0217-4//O /285*6-2'5 PHONE NO:. €7/ 4220 --5-2-63 <br />E-MAIL ADDRESS:OCTAU /0 /4)5&45 37 600< 1/4/9/6 . €0-n- <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: $-fi- Coo SUBMITTAL DATE: . 1 <-7 <br />FIRE SPKR: YES / NO A/C: YES / NO FLOOD ZONE: < PROCESSED 5-11 1 L.1 <br />RES. DEV. FEE: YES / NO PRIOR DWELLING UNIT: YES / NO COMMENTS: <br />PLANNING OK TO CHECK & DATE BLDG. DEPT. APPROVAL & DATE <br />PLNG CONDITIONS: <br />A