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I
<br />a o
<br />APPLICATION AND
<br />PLUMB!NG PERMIT
<br />(TYPEWRIIE OR PRINT IN INK)
<br />APPLICANT FILL IN AREA BELOW
<br />CITY OF SANTA ANA
<br />206 w 4th Street
<br />6€,7-273a
<br />hN,
<br />@g
<br />I2o
<br />ao,
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<br />N
<br />\r
<br />r/
<br />0
<br />c
<br />f
<br />t{o.EACH
<br />2Qo
<br />55
<br />5.00
<br />r.m
<br />5.m
<br />Or|...tlrL! O.drabG
<br />I fpr.6y .rt.h rh.r , .D .trnDr hoD tlr C@rr.cro/r L'cde l.r b. ri. tolloiig r.ron ls.c
<br />7001 5 8(,'lr... .rld P,ol6]o.r. co.. Arry ot, o. cou.ry *hlcn ,q!'.- r 9.rdr ro coiirtrecr
<br />1r... rhcrm firndrrr. o, ..r.. lny rndul.. ,i6 lo 'r. rru.nc.. .llo r.qurn t .ctlrcr.l
<br />io. rrcn ,ardr ro tE . arc.- .rarainarn tnar ha '' nc6ild 9!6ead ro rha Prov[arn oi m
<br />conrt cro.. Lr...- ld (chrrr I lco'r lo., hh s.do 7@) ol on.lo r 3 6a !r.g{fit r..nd ProLr..!. co&, o, It5l h. lt .trh9i rLrlarm ..., i!. !-. d tn *!-
<br />.r.6lclloi Any roar|o.r ot s.croo rBl 5 Dt rry.ccr..rn b..9..nir..4.cn ln. p ctrr ro
<br />. c'v'r Foty ol .ol no.. rr.. tv. n nri, (blrr'r 65@)
<br />O s."to" roge Irdn .ol ln. prq.iy.d.itornpbr-.r'rnrrg-.. rxntoEco.ts.G
<br />tarro.r dl (b lta roa. a,!d tE rlt,clrrr! ! .or .{adad r oalra., b. rda
<br />E S."r- zorrs r. - osr ot trr ,.o!.ay. rn .rdrlr.ty cort,-tn9 ran lE .d
<br />cornracldt lo corsld tu p.lract
<br />On
<br />-
<br />Orr.r (99 )
<br />Ternporary Gas Servbe
<br />Whtsr Healer - Eleclric or Gas
<br />100.00
<br />5.00
<br />10.00
<br />8.00
<br />CONTFACIOFk .\lo, rr/nrra Ce,r.r-rclz-32q -6tolPHONE
<br />4.002-O-1 lO s Lc'ArPtrpoO
<br />aoohEss 0
<br />r0.mCITY
<br />d,r.f?Sorr)
<br />STATE/ZIP
<br />cA 109q6 6.00
<br />Bain \ hter Piping (burbd) Ea. 1m'
<br />All. or R€pair of Drainage - Vont PipirE
<br />.Eain Sy$€m - Fer Orain
<br />\rvater Piping Ea. 100'
<br />Water Soflner
<br />Lafln Sprinkler
<br />10.00
<br />8.00
<br />I na.by artrm lhai I an |rctnlad !.d.r ttE p.o6loB ot
<br />L
<br />Cr(b. Ii! 6y haar, 6 '. lurr lo.ca ..d .ti..l
<br />e--<5
<br />lo.Lr Ccrtan &i o.d.aci
<br />r rs.6y.nr6 rMr I h.-. o.r tc.a ol @lu.llo-rl-'^&o, or. alrlral.oa lrb.t- a coG
<br />9.r!.16 rEd.^o Cdi'i.d @pt . nbd rnn tr crry b!'k 'n9 '.rp.crrsr .br.dnlnr
<br />I c.rl.t lh.l 'nln.D..lo.h.dolIn wort,o.rnl.nlhl'Carm ra arrad.I ah.ll trol6doy.ny
<br />!.rlan '. ..Y dn to o ro b.6m lbr.cl
<br />ra.aki t AFlcttr:
<br />ll.ir h.rr69 lnl. cdrncd.olEtcfipr'o.r, you!ho!lr, b.coD.rlbt cirorh.worr./. conc.]Ll6. p.@r.lo.ra ol lha Lbor co<r.. yoo hu.t lonhrth @opry rnn llJch ,ovr]d|t o. lha
<br />,.rDt .nd !. d..nr.d rtlorn
<br />th. wdtdr comr.,firbn L.r. ol
<br />on.
<br />-
<br />ADpr€.d (slg)
<br />*," 5 ' 1 1: Y1 ^0,'.-, ,
<br />da
<br />EtPr|r.
<br />-
<br />tritLo t l9g.l
<br />tl R6id€nlisi D lndulfiiel D Comrn€rclel TOTAL
<br />FIXTURES
<br />eadr plumt*E fixtuG/lrap
<br />Oental Unil or Medical Gases
<br />SEWER
<br />lst 100' + Conn.
<br />Ea. Add'l Conn.
<br />Ea. Add l 100' or Fraclion
<br />Prival€ Se$€ge Disg System
<br />GAS PIPING
<br />GAS S€RVICE 1 to 4 Outlots
<br />Ea. Add'l Ortel
<br />@at or F€pl@ Gas PipirE
<br />MISCELLANEOUS
<br />10.00
<br />5.00
<br />10.00
<br />r5.00
<br />5.m
<br />5.00
<br />30.00
<br />l4flol
<br />nr p.. .h.r a$.a t r rarari .ra b.co.. nrl frd vo.d 'i lll m.t f,rtc!- !' hl
<br />,.rlnt. mr coo.rric- rinr. ro.ly. noo fia da. ol tr.. F rl o r irr.ur!rt.d D, !r.
<br />,.mn ! qrc..xad or .orxb.r.a r ,ry trD dE rrr rgt .t cqtrn.rrd ra. . Friod oi lD(,.y! A ,rr a..frr rhj b od.ri.a i.e b.lar rrdi rst c.. !. rEdrrra.d
<br />ld.-iloffir
<br />r cl.rrt lrta r i.!. rd ln..lrclt,.noi .trd ,l. rhd nl..!o. *tlofitlo. a co.rG r .lr!b
<br />.o..r, hlh .rr oly o.dr[!rc- .nd rnl. Lr r.rah9 to bo .160rrrtu'[d r.9..nLlD. oi ln[ cny ro dnr upo^ tll .bo*rE\l
<br />u,,lt2-27_(mhimume-
<br />5.00
<br />10.00
<br />3.00
<br />10.00
<br />r0.00
<br />5.00
<br />5.@
<br />1.00
<br />Pool Traps
<br />\rvater Servrce Ea. 1m'
<br />D€ct( Dra. Sysem - Fer Orah
<br />O\€r 2"
<br />R€pai/Alt. Drainaga or \lenl
<br />Backflow Oevice 2" or Less
<br />Vacuum &eakers 1-5
<br />Ov6r 5
<br />Subtotal
<br />Penalty Fee (wheo applicable)
<br />Vdalloi Fee
<br />PLen Ched( 65% c, $btotal
<br />Phn Ch€ck (Adiunm6r{)
<br />lssuanco Fee
<br />TOTAL PERMIT FEE
<br />DATE
<br />(so.m)
<br />Dale
<br />(minirrum 2O.m)
<br />A€ceipt t'lo.Pc*
<br />P€FrMrl rssuEo BY (s]lg )
<br />BUILOING rv1rl.v€hrFrEo 8Y (slc
<br />Js.E4 tzo
<br />vALro^Trot (oFfrcE usE oNLY)
<br />|ACCOUNT TT r-ara
<br />OBr.rbur'o. 1r..9..ro.CoCy ? t.l.Copy 3 F'n.^c.C@y a Appr'c..iCoPy
<br />cs-6r I
<br />\lbste lnlerceptor
<br />n,fu
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<br />I s|r'l<e?1
<br /><lf1^n G."'knNaA Arvn
<br />8 o:l
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