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CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT 3/2/05:forms/Bldg.App.Worksheet <br />PROJECTADDRESS: 202 25-N- 0 l ;ue. 91+SUITE:SAPIN #10 1 1 9*a <br />USE OF BUILDING:gRESIDE!B>COMMERCIAL INDUSTRIAL OTHER <br />MASTER ID# <br />NATURE OF WORK:NEW ADD AVERITh DEMO REROOF REPAIR SIGN MISC <br />NFW/ADDITION/Al TFRATION· <br />1ST FL.. <br />2ND FL <br />4 <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) : Eoc·F EADUIA+6(l 90<Or- <br />i> OM# 34 pakely'. C. 0 16 0/k'(,v·- 7553 4.419 4-1)frt_ pallol <br />BUILDING OWNER'S NAME:D „IA-Gl W Ovwtte uoup.1-- <br />ADDRESS:CITY: f <br />2.035- /0. 6 l,·ut- 9 5 a /4.4 .,4. <br />TENANTS NAME (Comm/Ind): <br />CONTRACTOR'S NAME:STATE CONTR. #: <br />5nlar Cit·v Y Y'yto¥ <br />ADDRESS:CITY: <br />el & 5- 4. 44,4441 +Ut 5 ,4 4/,w <br />WORKERS COMP. POLICY#:EXP. DATE:INSURANCE COMPANY: <br />9(766106626 9-01-3 9/1//4 -&41 204 <br />ARCHITECT/ENGINEER:E - Poutret STATE LICENSE # <br />-4 bed arln *0*.(1522 0 1 <br />PHONE NO: <br />79-742-55-33 <br />STATE'ZIP: <br />LA 9 2706 <br />PHONE NO: <br />LICENSE CLASS:PHONE NO: <br />8 <br />STATE:ZIP: <br />C k.9270 6 <br />SANTA ANA BUS. LlC. # <br />PHONE NO: <br />ADDRESS:CITY:STATE:ZIP: <br />CONTACT NAME: 91 MV Dapt)PHONE NO: 7/q- 72#.,q76q <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: $52 LI \ (0003 SUBMITTAL DATE: <br />FIRE SPKR: YES / NO A/C: YES / NO FLOODZONE: . PROCESSED <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: