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CITY OF SANTA ANA <br />BUILDING PERMIT APPLICATION WORKSHEET <br />PLEASE PRINT <br />PBOSECT ADDRESS. 2570 LA/ze>91/4/,A)7- /94/ 6-SUITE: <br />ree-- ---0- <br />USE OF BUILDING:dEREE!8L->COMMERCIAL INDUSTRIAL OTHER <br />3/2/05:forms/Bldg.App.Worksheet <br />SAPIN #1(3191240 <br />MASTERID# <br />NATURE OF WORK: NEW ADD ALTER/T. I.DEMO REROOF REPAIR SIGN MISC <br />NEW/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) : <br />0>9 56-ten- 7/1/FT-pu_ 9 PAA)646 n-00 F Mo Wl- <br />1.-0 00 0-% 4862> 14-10 <br />BUILDING OWNER'S NAME:PHONE NO: <br />049 6»09/6/-32-3 -3/6 -g767. <br />ADDRESS:CITY.STATE:ZIP: <br />25% o LA,ne/·21400,JT Au 6 .S /107-F} Ar e 4057 f 2-706 <br />TENANT'S NAME (Comm/Ind):PHONE NO: <br />CONTRACTOR'S NAME:STATE CONTR. #:LICENSE CLASS:PHONE NO: <br />16,20 &US/1 4 9 <br />ADDRESS: <br />WORKERS COMP. POLICY#:EXP. DATE: <br />E VE i«YPT <br />ARCHITECT/ENGINEER: <br />ADDRESS <br />9.6 34/) 7 .999 37/- /3-53- <br />CITY:STATE:zIp:94 70 <br />S Ad-A P .E 6 P #W 6$. C.A -*,220 1 <br />INSURANCE COMPANY:SANTA ANA BUS. LIC. #: <br />STATE LICENSE #:PHONE NO: <br />CITY:STATE:ZIP: <br />CONTACTNAME. 0,5771 1//O 9526: 65 -PHONE NO: *7 20' 978 -3-2-63 <br />E-MAIL ADDRESS:OCTAvto p..GSALES -;A*, 4/•L AlL. er»n . <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: $40/(fOLD SUBMITTAL DATE: c-(- <br />FIRE SPKR: YES / NO A/C: YES / NO FLOOD ZONE:PROCESSED 69f <br />RES. DEV. FEE: YES / NO PRIOR DWELLING UNIT: YES / NO COMMENTS: <br />PLANNING OKTO CHECK& DATE BLDG. DEPT. APPROVAL & DATE <br />PLNG CONDITIONS: <br />e'