4tiLtcxtoN AND
<br />IUIECHANICAL PERMIT
<br />o o
<br />ITYPEWRITE OB PRINT IN INK)
<br />CITY OF SANTA ANA
<br />20 CIVIC CENTER PLAZA
<br />834-4186 f/rA
<br />APPLICANT FILL IN AR BELOW
<br />@g
<br />Izo
<br />o0,
<br />F
<br />545-)gELnanu-tL
<br />9a,w. .,-
<br />LZL\ 9 MV_
<br />12rd,.d
<br />t'" s.A
<br />Ownc. Euillnn Oeclaral'o,r
<br />ho.. lhm rhn tundl.d do{.6 (95OOl
<br />D so.ur rOree l. 8 orrx. ol rh. ,ac..ty, or ,iy @r
<br />9..r..tb., wl & Itr. Et, d tt rtrrcl!6 i. rcl nt .r,.d
<br />D S*tion rOqg l. .! o*m. ol th. pr@.ny, sm .rclu3wry cmr..nn! wln lrc..-d @
<br />t&lor! lo co.r&uct tryoFcr.
<br />O.l.- ovsrslc r-
<br />l?asSr*rov
<br />AilonEsszq*z lr1,ovM
<br />,,, ln..l"ff/-tolo
<br />?apq-'-{ srAIFrTrP
<br />,*^.2;l:7* .,* 84
<br />I ldt
<br />qz8 qzz
<br />Contrrto.Ut. Only
<br />** 4=l!'t\i'rac,o,,s,s r r.
<br />qz[,*l,ha
<br />L/
<br />Work6.3 Comp6n3ation Oocl6ralion
<br />ro rho \ b.r., 3 Comp..
<br />.4 -|-1942
<br />lc..!ty rh.r n lh. parldm.rc6 ol rh6 wdt lo
<br />l,, rrr.r rd'nC rhs C.ir'lE r.olE
<br />oro o.os.roi! o, th. L.bo. Codr,!l b. d.fid r6tdt
<br />Notico To Applicanr
<br />tlr
<br />,.,en h ..y m.nn$e.!ro becomo $bFct lo
<br />cril.- A!er.a^r ts{ t-
<br />NO EACH TOTAL
<br />FIXTURES
<br />EACH FURNACE INCL OUCTSANOVENTS
<br />EACH AASORPTION SYSTEM
<br />IL|
<br />,)l
<br />, ,l
<br />EACH COMPNESSOB, BOILER- OB HEAT PUMP
<br />EACH AIR HANOLING UNIT
<br />MISCELLANEOUS
<br />800
<br />ltm
<br />r5.00
<br />22.fi
<br />37 50
<br />600
<br />I1.00
<br />l5.m
<br />22.fi
<br />37.50
<br />4.60
<br />450
<br />10.@ t
<br />200o
<br />10.00
<br />10m
<br />TOIAL PLFIMIT FEE . :
<br />| | ro oo l/O-T'ooof
<br />10.@
<br />6.00
<br />4.50
<br />ach Vent Fan Connscr€dloa Duct ,ry14ro
<br />6.m
<br />10.00
<br />6.@
<br />5.00
<br />6.00
<br />6.00
<br />4.50
<br />5
<br />PERMIT NO
<br />loa
<br />BTE?
<br />00F
<br />OATE t-
<br />Erdrrddr
<br />Th't p.m'r thtll6rp.o by I'm'tato. ..d b€.om6 n!ll..d vod ,l lhe wolk rurhonz.d by lh'! D{h'l L
<br />nol comm.nc.d wtrhrn 180 days lrom ih€ ddrs ol lh,s D€, hr r or I wo.k :orhoded bv th,! p€'m't l
<br />Appllcani ! D.chrano.
<br />t!rp..r&d d tbanddEd ,l .hy nru .ll.. Itr
<br />F.fr 3h., !. Ohra,rrd ,r!r 6.toE lfh wd
<br />iort 13 cofr@rc.d lo. ! D.rEd ol 18O drv! An w
<br />Distribulion: I lnspGctor Copy 2. Fil€Copy 3 Finance Copy 4 Applicantcopy
<br />I +
<br />r"--1
<br />rs.oo I
<br />l
<br />d
<br />Fan Col lnstallalon
<br />Dry Chsmical Sysbm
<br />Each Ev6por6tive C0016r
<br />lnc'denrrlG6s Piprng
<br />Fr16 Damp6l lnstall6tion
<br />E6ch Applianc€ or Equ'pmenr Rsgubr€dby
<br />rh's Codo but nol spsc,tcally I'sl€d abovo
<br />Hood wlth Duclend Frn
<br />t
<br />I
<br />-,,1: t f d^*r.., o
<br />^se.i,s."
<br />wYl -di,---,-J
<br />-siTR !tlgVALIDATION IOFFICE T]SE ONIYI
<br />laccouNT,lr-ar5r 3500:b 31ttse
|