HomeMy WebLinkAboutEL140018_Application - QuestionairePermit Application SOON Flower Street
Santa Ma, CA 92103
`......................... ..._....... ,... ..........,..........._........_.............. ,.... _.................. __.._...................... ,. ® ]14.68].8888
County of Orange ®T1a ss] ¢ass
Today's Date: I I d1 I I `' Permit N: 1 l0 4 DD O[
TYPE OF PERMIT
❑ RESIDENTIAL HIS)
❑ PLUMBING (PB)
❑ NON RESIDENTIAL (NR)
0 MECHANICAL (ME)
❑ GRADING (Preliminary) (GA)
,CI ELECTRICAL (EL)
❑ GRADING (Precise) (GB)
❑ SWIMMING POOL/SPA (SW).
❑ LANDSCAPING (LS)
❑ SOLAR (SL)
❑ RESIDENTIAL TRACT (RT) `
❑ DEMOLITION (DM)
❑ FENCE, WALL, RETAINING WALL (RW) `
❑ SIGN (SB)
'(Separate attachment required for multiple submittal) ❑OTHER
PROJECT INFORMATION
��1
Address of Project �! YFU CABS
DC- 411 EI-+{b'(LT C'nI
Address
City z o
Legal
Description:
Assessor Parcel Number (APN):
Location of SRd(Decimal Degrees): / Example: 33.687 / 11]]86
//��� 11 Latitude Longitude 1 Latitude Longitude
Project Description: KACA '?N� a� 411Ns 1 /1„141-f 1%1 L2 4M L% C�
STRUCTURE SIZE:
Total Basement 1==Floor 2^a floor 31,1 Floor
GARAGE SIZE SQUARE FEET: SITE ACREAGE:
Current Related Permits.
CONTACT INFORMATION
Owner Name: F4b��l ILLo2 /1-`ZEL,rI C� ttPhone Number: 9�1I-4/pb-1L}Zc-(
Owner Address. '> QE(-Ic fl!!I"-S y�. NEti/♦bf-T CIT3T' g2,ClT
!Address City Zip
Contractor: � fly-N IIrrtY fYn ei License 0: g$Z �I -,
Address: I&5's a. /i't4 c.rTr'�14`.r 102 "S2.,IC C/A Phone Number: `I`f q-2'i8-9 93-,
ALc✓17
Agent/Contact Person: Sit ez Q,..,; Affiliation:
Phone Number. 91(t{r�.14 Fax: 9`(`I Email:
ARCHITECT:
Name License# Street#
Phone #
CIPUBLIC WORKS) OC PLANNING I3oo N. Flower Street, Santa Ana, CA gz]o3 1 PERMIT APPLICATION I PAGE I
Permit ApPliation n0%Lell
ENGINEER.
SOILS ENGINEER:
COUNTY OF ORANGE j OC PUBLIC WORKS IOC PLANNING
License e
City Phan, e
Applicable to Grading Permits UNLY
ENGINEERING
GEOLOGIST. /' / Streetp City Phanee
Name Licensee
CUBIC YARDAGE: CDT:
PROJECT ACREAGE:
TOTAL SITE ACREAGE:
FILL:
EXPORT:
WATER DISCHARGE I.D. NUMBER (WDID):
section must be completed by County Property
❑ CPP PERMIT NOT REQUIRED
❑ C,PP PERMIT FOR ENCROACHMENT PERMIT IS REQUIRED
❑ CPPAPPLICATION HAS BEEN SUBMITTED
DISTURBED SITE ACREAGE
,its (CPP) staff for gradil
❑ NO DECISION - ADDITIONAL
SUBMITTED
CPP STAFF NAME_
DATE AND INITIAL _
PERMIT NUMBER
I LLRT I FV NOwriR K C H A I L r IIR IN ratio MTV it I LHT no, WA V AND/DR EASEM ENTS.
Date
Signature
App)icabieto Sign Permits ONLY:
TENANT/BUSINESS NAME.
appucacrona
EDS TO BE
OCCUPANCY PERMIT NUMBER:
SIGNAGE ❑ Wall Sign ❑ Freestanding ❑Single Face ❑Double Face ❑Illuminated ❑Non -Illuminated
DETAIL:
Height: Length: Sq Ft Ground Clearance:
ADDITIONAL INFORMATION (i.e. Sign Co y):
DECLARATION:
DECLARATION:
I declare to the best of my knowledge that the information I have presented on this form and
alttathe applicationmacullsi and true
andn orrec .
I also understand that additional data and information maybe required prior to final ape
nt
information / documents may delay the [j 1 •.�
SCarl rlc-M
Print Nature Signature ate
m
STAFF USE ONLY:
❑ OTC ❑YPrLAN CHE�C/Kr, ❑lI�PLANN/NING APPLICATION ❑ PCRA ❑CE SETBACKS
ZONING'. �y>!iif�f QVq (,(/Qyf l'(- ❑Coastal ACTUAL: REQUIRED
APNe-. Nl3-1b j—oO ❑Flood Plain FRONT
LEGAL:
SIDE HO
���!.t� 'I
PA/CP. ❑Required SIDE(L)
PLANNER'S NAME:: REAR -
APPLICATION COMPLETE/
CUSTOMER CARE STAFF NAME INITIAL DATE.
(per related checklist)
OC PUBLIC WORKSIOC PLANNING Doa N. Flower Street, Santa Area, CA 917031 PERMIT APPLICATION I PAGE x
1—r AIN-IIon as/2.'r