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,o oAPPLICATION AND <br />PLUMBING PERMIT <br />(TYPEWBITE OR PRINT IN INK) <br />CITY OF SANTA ANA <br />206 W. 4lh Slreet <br />667-2738 d..v{ <br />APPLICANT FILL IN AREA BELOW <br />@c <br />I2o <br />oo:0 <br />AJ <br />o <br />fl <br />? <br />s <br />z' <br />I <br />A <br />cs-6rr <br />N. A44t^\ <br />Tr(7 <br />-fr <br />NG AOOFESS <br />-3r'-500 <br />I CtO <br />500 <br />1m 00 <br />Orrr-aL. D.d.tbr <br />rn r.6y.tnrh rh.r I.m !r.6pr |106ltr cdrr..clo/. L'c.rrl. (a id lt ldrdrp r...on ls-t6r 5. a6'n.- l.d P.oh.!o.r cod. Ary ary or cosnly,hlcn r.qufl. r F.nrl lo corlMl, <br />rl.r, rmorov.. (bmorllh. or r.c.f .ny drucrur, pnor lo ll. 'r.u.nc.. .ilo r.qun . tn lcplic.nl <br />lor 3rch D.rn ro tlr r i|9[|d.t l3rl.nl ih.l lr ! xc.na.d FrEu.nl lo lL P,oe.bru ol lh. <br />Conrr-ro/s trc.n . L!, lch.rrd I (conrr.icng rlrn S-r'o. 7@) ot olv!'oi 3 ol lh. <br />B6'n.r. .nd ProL.&oii. Coib) o. tlr! h. l. .rmri n r.lrofi .ra tl. bB6 io. lL .ag.d <br />.r.nprlon any vlor.rro.l 6l s.crbn rBl 5by rny.ttPxcrd l, r p.mrl rlbt cb ln. arphc..l lo <br />a ovrl p.n Iy o, nol mo..lhrn nv. hlndrad .k'll!.l (3!@l <br />E S-r,o" rO{e r. ! o*rr. ol rho 9roc.iy. o. mr..nrbr-.r'ih w.g- r.lh.r.oa coinFG <br />r.r'oii. rn (b ln. m.t. .r(, rh. drlrcrur l. rEa rri..r.d or otlrld lo..& <br />O 9.r|o. TOaaB l, .r 06, ol th. p.or.rty, . .tclurhrdy co.llrEnng *nh rrc.o..d <br />co,n[do.r ro corr.lrucl rn. Fol.cl <br />(-. <br />Fomm€,ca O.EACH <br />each plumbrng irlLrrenrap <br />15 00 <br />ea Add l Conn <br />E6. Add I l0O or Freclron <br />305m <br />E Resrdentral E rndusifial <br />Oenral U^n or Medrcal Gas€s <br />lst 10O . Conn <br />Pnvale Se\Nage Orsp Syslem <br />5m <br />500 <br />GAS SERVICE 1 io 4 Ourl€ts <br />Ea Add l Ouila <br />Reparr or Roplace Gas Piprnq <br />Temporary Ges Sorvic€ <br />FIXTUFES <br />r0m 2-anll/aler Ptprng Ea 16 ?-f3ouorxa,l P/-a*. <-a <br />PHONE <br />6gz -ass Rain Waler Piping (buned) Ea lm 800 <br />t2t o O. BAak/-<v 4u.ADORESS <br />400 <br />All or Ropetr oi Orernage - V6nl PipingsiatE/zrPn66AcrlY <br />oftG. <br />Lawn Sprinkler (incl. bEckflow) <br />10m <br />600 <br />l0mRlio SFlom - Por Dr.rn (insrd€l <br />800lnd Wtsto lnte.ceptor <br />Pool Trap6 5m <br />I h.r.6y lltrrm rh.r I .n lic.n..d l,xld lh. p.o!i.iB ol Ctr. .. L On.ion 3ol lh.Au.ir'..!.nd <br />Foi.3c qod., id ,ry r'c.ir. ! '^ tulr ldc. .,rd .d.ct <br />o",. I o:lV l."--* 9z!:?/".., <br />3m <br />10 00 <br />5m <br />Roo, Dr3in 9n6rn - P6r O.ain <br />Rop8ir/All Orain8gs or Venl <br />V8cuum Erett€rs 1-5 <br />Over 5 1@ <br />Eaclllor Oeiice 2" or Less 500 <br />10movet Z <br />r..r'r coir. &6 o.dNtr' <br />I h.oby .rnrm rhlr I hrve . csnrlrc.te ol @nsml lo ellmlure, or r con rc.lo or wo*d . Con <br />retortts* <br />I.n md'.g |n.a crntca.olErrtrprqr. yo! $orrld b.cod.llqcliotEwdt /r@mc.rt <br />!.rEn p.o{.!€n oa ltr Uao. Cod., yoq ml!| io.rbah corDr rlh tuch !.(rib.r o. lh. <br />p..tul anlll ba &amad rarorad <br />rn!p.crr@ d.p.n@^r <br />r c.n8 h.r '. rh. p..ldrum.ot ri€ rort lor r3 !&a(i I tn.ll .Dl mdoy tny <br />Frto.r n any dx,td s ! to b.co.rr. .u <br />t70-Subroral <br />Psn8lty Fe€ (whe6 Epplicable) <br />Violalion F€e (minrmum 15O.00)il1,&Plan chect 65ci ol sublotal lmmrmum tl5 m)l2,lio <br />Receipt No <br />-PCNorOTAL PEB TT fEE (mhhr,|n ta5.0o) <br />L291 8oIoxz /D _-97 PERTIT I{O, <br />E r-o.r <br />Th[ o.rm( th.u .rc'r. !y r'm[to.r .nd b.com null ed ad rl rh. rcrt aurho.':.d by !trl. <br />FrD( i! nor conmncod withn r &.,.y. l,om th. (Ll. d lhil p.rmil o. it rcrt .utho.i:.d Dy l6np.rnrr6tu.p.n.ado..b.n.br!.dcDyrin.t..th.rorii!cornrLc.diorrF.rbdolla) <br />d.yr a ,x* p6d( ,r.rr b. obLr^.d nd !.1o.. sh ro.l c.tr b. .conm.rE d <br />Ata..dlt lrda.rr <br />I c.n y rh8r I h.w ...d rhB .pplrc.r'o.r .nd .lrl. lhrl tn. .bav! into. lbn it corr.cl I .9r.. lo <br />€ornpry * h .rr oty odiM.c- ..d !ttr. lrE r.lrlkie io bulrdln9 cdr.luclb., od h.r-y <br />on" /9r!2:17 <br />DroDa.rY io.'.rapclro.rrrrron:.d oC.-.ot]!o.r o, tnl. ciy b <br />U ,/krrn)" IPEFMTI ISSU€O 8Y (99 )Ei'l'",9i8. ?96, I *",.,.o "" *, <br />llLidriibFro-FEdE u*oNrY)taccouNl rr r-ar2) <br />oBrnborron 1 rnrp.cbr Copy 2 frr. Copy 3 Fh.nc. qocy -a,-Aopl'c.ol gopy - <br />,-a <br />r0 00 <br />TOTAL <br />-la)7.n T',..I I rom I <br />SEWEN <br />.ls <br />30 00 <br />*""** <br />r SC€LLANEOUS <br />Weler Healer - Eleclrlc or Gas <br />I ?7AO r1T?d <br />tr. liro.td. comr.or'on Lil ol <br />35?l