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aPpuceloN AND
<br />PLUMBING PERMIT
<br />ITYPEWRiTE OR PRINT IN INK)
<br />CITY OF SANTA ANA
<br />200 w. 4rh sr.
<br />(7 14, a1t-64ta ffiio
<br />APPLICANT FILL IN AREA BELOW
<br />@c
<br />9zo
<br />oo,
<br />q)
<br />u.o
<br />t
<br />u
<br />B
<br />$
<br />R
<br />t
<br />JOEAOOsESS
<br />STAIE'ZIPo"-6
<br />E tndustrist ts{omrnerctal
<br />ln l0O' + Coon r0 00 /o-
<br />o EACH TOTAL
<br />each plumbing lixture/lrap 400
<br />r0.00Dental Unrt or Medical Gases
<br />E Resdentaal
<br />FIXTUR€S
<br />300
<br />300Ea. Add l l0O'or Fr.ction
<br />Privale Sowago Disg Systom
<br />Ea Add'lConn
<br />30 00
<br />GAS PIPING
<br />500 W
<br />r00
<br />500
<br />20 00
<br />GAS SEBVICE 1 ro 4 Oullels
<br />Repair or Repl6c6 Gas Pipino
<br />Temporary Gas Servics
<br />Ea. Add'lOurler
<br />I ri..br .llm rhn l..n.r.hCt,roin nt. Cclt &to. ! U.tni Lr* lo rh. lollsiC,{E r ts.c.
<br />,O3l 5. &v!... rn ProL..dr. Cd. A.v ory d co-ly ,h.h ixird . Dn nr ro cooinrr'
<br />.rnr,.no.on. rlnErtr. d r.O..! rrt nrxrrr., .,'o io tu[Jricl,,.o,rqord,..pdr. rd
<br />$.r! ,.rmn to ll| . nertd n.r.nsr ln.t hi lt rc.6rd !{.!r,.nl o th. p.ovl.6r ol ih. cmr...
<br />ro.l llcm$ l.w lch.Ord 9lco.tuDlc',lo w'th S.cro.t ,O0Or ol (rrto. 3 ol th.lorn tr mdPrd.tsdnco(bldtr.rh.'..!.rn9in r.l.dn$ddrDaarlGft d.9.d.I.ingr..i A^ylo.}
<br />r..t ol S.ctd! 7O3l 6 by,ry.oola ,... c!ftr !!Fn Lh.o!ac.nr |o. cnir p..drr ol mrdn h,l liE h,.d.d doL.r laSOOl
<br />0 S.",ir, rOaae l..r rolrn p.oC.ny, o.niy. ororr.rsrh*t! !.r rnr l.r..dn-
<br />C..t .rs, ,ll (b it *st, ,rd rh. ![(,crur. .t mr .l.irr.., d otlr.d ld t r.
<br />C) S*,i- rO{g l. .r o,r ol ,r. !,oE .n. h .rcr,rviry co.r'.cr.ro urh [6o-d co.]
<br />r,acro. ro co.lrnd lt.,.,i.cr
<br />Orn.rBulld.. O.cl.rlllon
<br />o.i.- ori.. t9s
<br />MISCELLANEOUS
<br />Wster Hoater - Eloctric o. 66s 500 ao-
<br />Water Prping Ea 10O'
<br />/g 4.00 /2-
<br />4.00R6in W6rer Pipinolburi€dl Ea. 10O'
<br />water Sollener 400
<br />All. or Repair ol Drainage -Venl Piping 3.00
<br />Lawn Sprinkle,3.00
<br />Hain SWrEm - Per Drain lihsid€,
<br />lnd Waste lntorcopto.800
<br />500
<br />3mEool Drain System - Per Drain
<br />Fapair/All DraioageorVenl
<br />PoolTraps
<br />300
<br />Vacuum &eakers l-5 500
<br />Ov€r 5 r00
<br />Eackflow Devic€ 2'or Less 500
<br />I arn Lard undd nf, p.turst ol Ch.!r., 9, DM3s 3 ol fi. au!d$ .rn
<br />Prol..E!! Co(b. d rr r€6r. I 6 rul re. .,ld .ll..t
<br />I hd.!y rtt.6 rMr I tu€ . cir.ra.r. ol ro.,hr ro xll
<br />I cnnly h.l n rh. o..ldlrlft. ot th. wl ld rnEh
<br />faodc. to AD9aofri:
<br />,. d5 m.l,t! l't C.d'c.r. or Erdipio, ro tr,ld b..dr r,bFr ro dr t\b,tr'a CdrE|
<br />xio,r Po'ltotr ot ir. L.oo. corb, r@ 66r lorhrh cdllorr rir Et o.dto.t o, rrrr o..irl$Cn .rnrn.lnvot.,
<br />Coor.cto. U.. Only
<br />ss
<br />STATE/2IP
<br />PHONE
<br />/43 s'7 /
<br />o",b:2bt1
<br />c.n'l.d c@v ,i ri.d, h rh. c'rY
<br />ri 6s.d, I $ai nol.moloy t.y
<br />o.rron 'n a.v ru.{r '. a lo ba.6a rlDnd |o ltE
<br />tBSa-/
<br />. c.,rna.G or r rort.. , Cdro..-
<br />o.r.- AFr.Dr rs.e I
<br />/34-
<br />7Z
<br />Vrdarion Fee ( InIlnoi a!t.OO,
<br />Plan Ch6ck Fso lminimum 315.0O)
<br />Ov6t 2"Irr,^
<br />Sublolal
<br />1-
<br />Penally Fee Iwhen applcable)
<br />rcNoH€cerpt No
<br />""a 31 42
<br />r.dl rlnalIn i r..d tE !!Ear.t
<br />.eQr..sr.rdroi n rc,l|
<br />0r.boE -dm.iM '..d,Er l.grF ro
<br />TOTAL PCRMIT FEE (m InInU'n .3I.OO,
<br />o^rE b.AU. Ei?
<br />lssuance F€€
<br />V/,tcd,t/-.,SUILDING
<br />Frano0Yrsg r PtnMlI|SSUEDSYlSrq I
<br />v LroaroN roFrcE usEonlYtlaccouNlr r l2r
<br />a
<br />rrlr
<br />I
<br />DisrriburDn I lnspecror Copy 2 Frlecopy 3. Finsnce Copy 4 Applicantcopy
<br />SEWER
<br />400
<br />7
<br />r0 00
<br />PERM]T NO,
<br />o D.
<br />C!rhrbi
<br />Trrr !.rft1$arrll . try rn.tt|6.6d D.co.rr 6ur..d vo|d d rh ro.t .urhon td !r tnir !.rm!t !.orcnnrift.d*rn lEo {r.y! l,@ tti d.r. ol rhlr !.rfit d n wo.r.00lo [.d Df thro..,rt !tlsri(,.d d.h..r.bia .t.ir !.E.i.. rr. dt.. cdwEEtd lo.. ldrod ol l&d.y.
<br />^
<br />i.'
<br />Ertt d h. olEr.d f,n bir. r,.h *sr c, t cdtrErod
<br />ApCo. '. O.affioo
<br />.6rt inh.r.'l,r odd|ra
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