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CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT 3/2/05:forms/Blda.App.Worksheet''' PROJECT ADDRESS: g,2- 1 W, K.:p rt SUITE:SAPIN #1 0 1 &09 8-7 <br />USE OF BUILDING: ENTI COMMERCIAL- INDUSTRIAL OTHER <br />MASTERID# <br />NATURE 0F W0RK: NEW ADD ALTEIVT. I.DEM0 RER00F REPAIR SIGN e so kr fbi <br />NF.W/ADDITION/Al TFRATION: <br />1ST FL..SF <br />2ND FL.. SF <br />TOTALOF OTHER Fla SF <br />GARAGE/CARPORT: SF <br />JOB DESCARIPTION (noll-residential projg <br />BASEMENT: YESlNO SF NO. OF STORIES: <br />PATIO/ENCL. PATIO:SF BLDG. HEIGHT: <br />RES. REMODEL: SF PROPOSED USE: <br />ALTER/T. I.:SF <br />:ts seg reverse side of thib application) :© lar·PU syslh. 6,7_9+AvIn + 2/27* f}lg,in 12?nd <br />CA FG< <br />BUILDING OWNER'S NAME: Th h 4099 PHONE NO <br />ADDRESS:3521 \P. kert <br />TENANTS NAME (Comm/Ind): <br />CONTRACTOR'S NAME:<-boLrmAx <br />ADDRESS:027 121-1 54 <br />WORKERS COMP. POLICY#:EXP. DATE- <br />-7/7Z6637 4-L-14 <br />ARCHITECT/ENGINEER· <br />ADDRESS: <br />CITY:,- ._ A <br />De,A I Q A IP <br />STATE CONTR. #: <br />972-049 <br />CITY:4 A W <br />INSURANG# COPANY <br />t-'egeer I <br />STATE LICENSE#: <br />CITY: <br />STATE:31,4 ZI'l»-9-,utt 6 14'T \ <br />PHONE NO: <br />LICENSEi CLASS:PHONE NO: <br />CLA 951 -30 -0763 <br />STATE:(32< ZIP.929-7 <br />SANTA ANA BUS. LIC. #: <br />PHONE NO: <br />STATE:ZIP <br />CONTACT NAME:Fr tan 5 IA)294€V PHONE NO:95) -3(27-0169 <br />E-MAIL ADDRESS: Ot-1 Can-5 () S» 1/5 r rrw,x--gch, Com <br />OFFICE USE ONLY:ACC OR SPC (CIRCLE ONE)HRS PER BLDG. FEE $ <br />OCC. GROUP:RECEIPT #NIA P/C FEE PD $ <br />TYPE OF CONSTR:VALUATION: $15,79)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 OKTOCHECK& DATE BLDG. DEPT. APPROVAL & DATE <br />PLNG CONDITIONS: <br />041 <br />i