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CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT <br />PROJECT ADDRESS: | {/( 8 Fils¥ 9'rrecA SUITE: <br />USE OF BUILDING:RESIDENTIAL GMERCIA- INDUSTRIAL OTHER <br />3/2/05:forms/Bldg.ADD.Worksheet <br />SAPIN #10 les Lisp <br />MASTERID# <br />NATURE OF WORK: NEW ADD ALTEFVT. I.DEMO REROOF REPAIR gSIGN_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 ALTER/T. I..SF <br />JOB DESCRIPTION (non-residential projects see reverse side of this application) : <br />djvrn 1 nA-d Ina[\ 5316 4 molbll-]mEnj 35]1rt. <br />BUILDING OWNER'S NAME:-PHONE NO: <br />-Ran - pu l +Dra k '119- U Dul- S IMO <br />ADDRESS:CITY:STATE:ZIP:i 039- r- MAO prvIA.1 Av€-Orar- PA 01296,9 <br />TENANT'S NAME (Comm/Ind):CNF PHONE NO: <br />CONTRACTOR'S NAME:STATE CONTR. #:LICENSE CLASS:PHONE NO: <br />& 1,<:SU) t leNS 1 00 15(0»1(4 r,LIE- 31,-102*11-11 <br />ADDRESS:CITY:STATE:ZIP:1-nlo Ma•*AA•n &906 %(v \A 4*=C Monha411 16:Ach f€ A 0-2 elp <br />WORKERS COMP. POLICY#:EXP. DATE:INSURANCE COMPANY:SANTA ANA BUS. LlC. #: <br />AltCHITECTIt14R:/1 STAr LICENSE # PHONE 7 <br />ADRE CITY: 'C--" <br />/Up< Li <br />CONTACT NAME:.=Gon M on·h /,1 PHONE NO:SCh ,(07-0- 91-1-7 <br />E-MAIL ADDRESS: -52ison #D /»€SCO Skyls. 60- <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 <br />i <br />PLNG CONDITIONS: ./ 4