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CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT 3/2/05:forms/Bldq.ADD.Worksheet <br />PROJECT ADDRESS:'3\& n N AM¥ Av €SUITE:SAPIN #/0 f€)osf <br />USE OF BUILDING:-SESIDENIIAL COMMERCIAL INDUSTRIAL OTHER <br />MASTERID# <br />NATURE OF WORK: NEW ADD ALTER/T.1.DEMO REROOF REPAIR SIGN MISC <br />NEW/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 ALTEFUT.I.: SF <br />JOB DESCRIPTION (non-residential projects see reverse side of this application) : 14· 25. MIA( P•W>IY\ovm-cd &616lt <br />Fl Vane\X 1 n mic.wo-*1%11-cts, \ (480(*1, 75' EN\(AvA- <br />BUILDING OWNER'S NAME.\N<*am E\Wer PHONE NO: <br />ADDRESS:bu\1 W *AVW N€ <br />TENANT'S NAME (Comm/Ind): <br />CONTRACTOR'S NAME:Vivt-Al- go\AR <br />ADDRESS· 14981 N 560 W <br />WORKrRS COMP. POLICY#:EXP. DATE: <br />WC 0248#LgBE)11/11'll <br />CITY'STATE: ZIP: 01.1,105Sonta hi\A <br />PHONE NO: <br />STATE CONTR. #:LICENSE CLASS:PHONE NO: <br />41@lsw 0-10 r U (D t614(D-K252 <br />CITY. %04 0 STATE: UT zIP:74904 <br />INSURANCE COMPANY:SANTA ANA BUS. LlC. #: <br />A'Gr=@tmms_8454 170 <br />ARCHIT''ECT/ENGINEER:PHONE NO:r»-6 \Al Go <br />ADDRESS:STATE:ZIP <br />, STATE LIEISE # <br />CITY <br />CONTACT NAME:MAks™ MAna PHONE NO:l961-U 00· 725-2 <br />E-MAIL ADDRESS:09 Anqe f ownt,*\a* Id vival. Grn <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 DAT,%4-1 5 -) 41 <br />FIRE SPKR: YES / NO A/C: YES / NO FLOOD ZONE:PROCESSED e\01 <br />RES. DEV. FEE: YES/NO PRIOR DWELLING UNIT: YES / NO COMMENTS: <br />PLANNING OKTO CHECK& DATE BLDG. DEPT. APPROVAL & DATE <br />PLNG CONDITIONS: