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CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT 3/2/05:forms/Bldg.App.Worksheet <br />PROJECT ADDRESS:2%00 /U /1/1-/11 37)25£ 7- Sun-E: 3 0 8 SAPIN#/014 9908 <br />USE OF BUILDING:RESIDENTIAL COMMERCIAL INDUSTRIAL OTHER <br />MASTER ID# <br />NATURE OF WORK:NEW ADD ALTER/T. I.DEMO REROOF REPAIR 6!9©MISC <br />NFW/ADDITION/Al TFRATION· <br />1 ST rL.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. I.:SF <br />JOB DESCRIPTION (non-residential projects see reverse side of this application) : <br />1 59-T 6 e C/JAN MEL LE-TTE 23 /)UTE 2- N Ally 1 LLO k i NA-TE O <br />BUILDING OWNER'S NAME: <br />uj Ea'-rr i g c D <br />ADDRESS'CITY'2%00 B BAW'ST/zer SANT A- AVA- <br />TENANT'S NAME (Comm/Ind):ASHE <-Ev fa x <br />CONTRACTOR'S NAME:STATE CONTR. #: <br />/ NA A-Gl- 6457-2.Al %979/1 <br />1 , <br />ADDRESS:CITY: <br />010 C /ZE A)-9*9-0 4 L Los /1/4,66 2-5 <br />WORKERS COMP. POLICY#:EXP. DATE:INSURANCE COMPANY: <br />ARCHITECT/ENGINEER:STATE LICENSE #: <br />ADDRESS:CITY: <br />PHONE NO: <br />STATE ZIP'CA-92769 <br />PHONE NO: <br />LICENSE CLASS:PHONE NO: <br />e 6/5-323 964 /860 <br />STATE:ZIP <br />CIA-00 AGS- <br />SANTA ANA BUS. LlC. #: <br />PHONE NO: <br />STATE:ZIP: <br />CONTACT NAME:6 ES ol /)-Go i t.-4-,2_PHONE NO:313 9 6 1 6694 <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 />PLANNING OK TO CHECK & DATE BLDG. DEPT. APPROVAL & DATE, 30(-C€ »3PLNG COND'I'ONS . 'g12> \1