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CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASEPRIN« <br />PROJECT ADDRESS:ll-too VTIC „4 0 u.)Ay SUITE: <br />USE OF BUILDING:RESIDENTIAL COMMERCIAL INDUSTRIAL OTHER <br />3/2/05:forms/Bldg.App.Worksheet <br />SAPIN #10199990 <br />MASTER ID# <br />NATURE OF WORK:NEW ADD ALTERIT.1.DEMO REROOF REPAIR SIGN MISC <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. I.SF <br />JOB DE,CRIPTIQN (non-re#idential pejects pee reverse side of this application) : L,09'k,E)6tta>dz-*6562·uhA./t:A-- c)- Gl.X AL/t 1 04-Q- *1.--t 0 <br />BUILDING OWNER'S NAME: r-1U B.l<-eJr t-'22>f' tLr[-i £_£1 9'(7 <br />ADDRESS:.+Bv 64- AAMUL,Refbk.7V 1 G. TD <br />PHONE NO: /9 71/ 395.3 293 <br />STATE: /7 f ZIP <br />92-49/ <br />TENANTS NAME (Comm/Ind):PHONE NO: <br />CONTRACTOR'S NApE90 Pe_¢2-ADA-, ati: c , AAN' · <br />ADDRESS/7 0 8 u). ANA-9 21 4 gr- <br />STATE CONTR. #:LICENSE CLASS:PHONE NO:96'2- <br />2-71 0 92'c 90 490 3 gor <br />CITY-STATE:ZIP:643 CA-9 Qf I '3 <br />WORKERS COMP. POLICY#:EXP. DATE: <br />U 8 1.-77 0/ Wo G A 4-/-tv <br />INSURANCE COMPANY:SANTA ANA BUS. LIC. #: <br />L-cALED,-) 7+R <br />ARCHITECT/ENGINEER:STATE LICENSE #:PHONE NO: <br />ADDRESS:CITY:STATE:ZIP: <br />CONTACT NAME:€7-Eve- IM; Q AOL©PHONE NO:390 4/arl - 590< <br />E-MAIL ADDRESS: SH' 2 perph i-F Coe hot,01@i L £44 <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: . PROCESSES <br />RES. DEV. FEE: YES / NO PRIOR DWELLING UNIT: YES / NO COMMENTS: <br />PLANNING OK TO CHECK & DATE BLDG. DEPT. APPROVAL & DAT <br />PLNG CONDITIONS: I 3 <br />L <br />l <br />k.--.