HomeMy WebLinkAboutN/A (5)76A667A ICE 817B) - 11/76
APPLICATION IPERMIT
BUILDING AND SAFETY
FOR APPLICANT TO FILL IN (PRINT OR TYPE(
DIVISION
BUILDING /
ADDRESS � � ^���d t /d,�! ��
/ �-
/ 4 !'.�T �
NUMBER
FIXTURE OR ITEM
@
FEE
LOCALITY
r v
i
WATER CLOSET
BATH TUB
NEAREST
CROSS ST.
SHOWER
OWNER t
LAVATORY
MAIL
ADDRESS %
SINK
CITY I L. N
p -
. f
DISHWASHER
CONTRACTOR _ 1
CLOTHES WASHER
ADDRESS m
SWIMMING POOL RECEPTOR
CITY TEL.
37-031
LAWN SPRINKLER SYSTEM
a
STATE LIC.
LICENSE NO. CLASS
DISTRICT NO / GROUP ZONE S PROCESSED�BY
WATER HEATER
GAS SYSTEM OUTLETS
OUTLETS OVER
5 PER SYSTEM
INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
Plan check fee
PLUMBING PERMIT ISSUING FEE $
TOTAL FEE
Ito
Plan check applicant
APPROVALS DATE
INSPECTOR'S SIGNATURE
Name
UNDER SLAB WORK
Address
ROUGH PLUMBING
City Tel. No.
GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THATTHE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE
LEGAL OWNER OF, AND INTEND TO $EAt�E IN THE ABOVE DESCRIBED RESIDENTIAL
PROPERTY. Ua,i' /J
SIGNATURE`FINAL
OF PERMITTEE Il
PLAN CHECK VALIDATION CK. M.O. CASH
GAS VENT
HOT WATER HEATER
PLUMBING FIXTURES
GAS TEST
UTILITY CO. NOTIFIED
PERMIT VALIDATION CK. M.O. CASH