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CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT <br />PROJECT ADDRESS: 52=, Civil<L 4.£61312'ED SUITE: <br />USE OF BUILDING: RESIDENTIAL C.SOMMERCI INDUSTRIAL OTHER <br />3/2/05:forms/Blda.App.Worksheet <br />SAPIN #jol EDS 61-· <br />MASTER ID# <br />NATURE OF WORK:NEW ADD GLTER/T. DEMO . REROOF REPAIR SIGN MISC <br />NEW/ADDITION/Al TFRATION <br />1 ST FL..Goo Se <br />2ND FL..(0 y <br />TOTAL OF OTHER Fla 6.00/ SF <br />GARAGE/CARPORT SF <br />BASEMENT: YES/NO SF <br />PATIO/ENCL. PATIO: SF <br />RES. REMODEL:SF <br />ALTERIT.1.: SF <br />NO. OF STORIES: <br />BLDG. HEIGHT: <br />PROPOSED USE: <br />JOB DESCRIPTION (non-residential projects see reyerseside of this application) : 1 KMEYZA C¥2- -1-1 1 . <br />09*4*t><22)/7 1;044 62 3 12,00[19=, »40KP Id 01,· eo ©Ne=,MosS ..£449 Er><f -Ill- <br />K*Lrit ote--1 ju a eet tix'i,A tjel FL#4-4 ,z«rus DE,-·c> tl-E <br />BUILDING OWNER'S NAME:PHONE NO:'- r'7U.bl.4 2= E srcmr' 4011 OF- 1261-07» ARA 14 - -'42£, a I'r' p £1CP, 1.1- <br />ADDRESS CITY:STATE:2,0 akliC, dAzy*0(2- Yit>3 1*>+4% 0>44*- Oh Mt-1 4 <br />TENANT'S NAME (Comm/Ind):PHONE NOO»1 Of> 1:*MB 544 A <br />CONTRACTOR'S NAME:LICENSg#LASS:-TFF PLY{#3 4 )f 56V 4 9 M \COWFZE:t; ING ST9111461 <br />ADDRESS:CITY:STATE:ZIP1-1-7-tt EA *.1)02- VA€-,»PL.€lb<· #>¢rh )>s-(4 921013 <br />WORKERS COMP. POLICY#:EXP. DATE:INSURANCE COMPANY:SANTA ANA BUS. LlC. #: <br />ARCHITECT/ENGINEER: 1 .STATE LICENSE #:PHONE NON. A <br />ADDRESS:CITY:STATE:ZIP: <br />CONTACT NAME:PHONE NO: <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 <br />PLNG CONDITIONS: <br />.4