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APPL!CATION AND
<br />PLUJI'BING PERMIT
<br />(TYPEWR]TE OF PRINT IN INK)
<br />o o CITY OF SANTA ANA
<br />206 W. 4th Streel
<br />667-273€6*
<br />APPLICANT FILL IN AREA BELOW
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<br />10 00
<br />Odd Fellows Lodge 972-9004
<br />Santa Ana
<br />I
<br />311 N. llaln
<br />309 N. Maln
<br />cA 92701
<br />Orirault, O.dr&.r
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<br />10.00
<br />8.00
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<br />CIIY STATE ZIP
<br />2-9004V 0. Z. Construct 1on
<br />309 E. 3rd St.
<br />Santa Ana
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<br />cA 92701
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<br />?*-ta_r49
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<br />,.m € &.o.n&d or rD.n!oo.( n ..y rrm .n.. ih. e,o.t r. cornracG, to. . F ird ol l&(,.y! A i.r p..rxr .n.{ !. od.n d nr, !.1o.. tr,ch ro.i cln n .t.offrrE d
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<br />^d'2.?2 ADplE.rx or Ag.nr (S'0 )
<br />prop..ly lor .Bpadlon
<br />Alt. or R€pair ol Orainage - \,bnt PifrrE
<br />s35.00)
<br />10.00
<br />10.00
<br />6.00
<br />10.00
<br />5.00
<br />8.00
<br />1.00
<br />5.00
<br />5.00
<br />3.00
<br />10 00
<br />\l/her Service Ea. 1m'
<br />Lawn Spnnkler
<br />Ovet 2
<br />Ran Syslem - Fer Drain
<br />Backflow Da/ice Z or Less
<br />lrd. $ibste lnlercsptor
<br />Owr 5
<br />Pool Traps
<br />Vacuum Breakers 1-5
<br />Deck Drain Syslem - Per Dran
<br />R€pair/Alt. Drainago or Venl
<br />Subtolal
<br />Penalty F€€ (wheo appli:Sle)
<br />Violation Fee
<br />Plan Ch€c* 650/" ol subldal
<br />PIan Check (Adiustment)
<br />lssuance Fee
<br />TOTAL PERMIT FEE
<br />DATE
<br />(50.00)
<br />Date
<br />(minirum 20.00)
<br />PERMIT NO.
<br />Fleceipl tlo Pc#
<br />D Rosilent6l J In&striet TOTAL
<br />FIXTI.JRES
<br />eei plumtirE fixtulBi trap
<br />Donlal Unn or Medical Gases
<br />SEWER
<br />1sl 100' + C,ono.
<br />Ea Add l Conn
<br />Ea. Add'l 100'or Fraclion
<br />ftivate Ssl^lage Dsp System
<br />GAS P|PING
<br />GAS SERVICE 1 to 4 Oullets
<br />Ea Add I Outlel
<br />R€par or R€place Gas Piprng
<br />Temporary Gas Service
<br />MISCELLANEOUS
<br />\ Ialer lbaler - Eleclnc o( Gas
<br />\r ater Pidru Ea. 100
<br />Rain Whter Ppmg (buried) Ea. 100'
<br />Water Sottner
<br />OJ
<br />10.00
<br />. O{l
<br />15.00
<br />5m
<br />5.00
<br />30.00
<br />5.00
<br />100
<br />5.00
<br />PEFMIT ISSLEO 8Y (99I
<br />-
<br />da vEFrlrEo sY t99 |
<br />BUILOING
<br />Jtattlv^rlo^iioN (oFFrcE us€ oNtYttaccouNl.rr-ara
<br />NTTIZ
<br />O'rrr'6ulDn t rnirctor Cooy 2 Frr.Cog, J a'ntnct
<br />k ffu"L
<br />rc. I ercx
<br />:)
<br />-+j
<br />10.00
<br />im.00
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