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CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT 3/2/05:forms/Bldg.ADD.Worksheet <br />PRbJECT ADDRESS: 2-5 Srt Evergreen 5 t SUITE:SAPIN #10 1%? )052-:5 <br />USE OF BUILDING:RESIDENTIAL COMMERCIAL INDUSTRIAL OTHER <br />MASTER ID# <br />NATURE OF WORK:NEW ADD ALTERIT.I.DEMO REROOF REPAIR SIGN 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): H.3 \(w 50\0< 9 v Fooirnount <br />\8 ?Bne\9 <br />BUILDING OWNER'S NAME: <br />3 Ailtr <br />ADDRESS:2153 Evt<gieen St <br />PHONE NO:5040 (7\H} 451-3414 <br />ClIY:STATE: - A ZIP: <br />>Ata and (/1 1 12.36? <br />TENANT'S NAME (Comm/Ind):PHONE NO: <br />CONTRACTOR'S NAME:STATE CONTR. #:(UP.clije W:sre. \Aotw t\(i So\* Cow) 41* 05 <br />ADDRESS:CITY: <br />7702- Lk\i ng(frnart 9\-,EC Mont< <br />WORKERS COMP. POLICY#:EXP. DATE:.INSURANCE COMPANY: <br />\\M'\6(& viole*l *coioN 1 /8 ( \H 1-2-WECDZ E 63 <br />ARCHITECT/ENGINEER:STATE LICENSE #: <br />LICE*@E CLASS:PHONE NO <br />((626)-94-\Roo <br />STATE .ZIP: <br />0 %13/ <br />SANTA ANA BUS. LlC. #: <br />PHONE NO: <br />ADDRESS:CITY:STATE:ZIP: <br />CONTACT NAME:pe\6 CBM&6 <br />E-MAIL ADDRESS: AC)r) |'\ajol< Cor-?· Cool <br />PHONE NO:(624 354 -2-611 <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: $32 L.1, aIl-su SUBMITTAL DATE: <br />b <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: