Loading...
HomeMy WebLinkAbout5679A76A667A CE 817 (REV. 6/76) ©s APPLICATION 1PERMIT FOR APPLICANT TO FILL IN (PRINT OR TYPE) NUMBER FIXTURE OR ITEM @ FEE WATER CLOSET BATH TUB SHOWER LAVATORY SINK DISHWASHER CLOTHES WASHER SWIMMING POOL RECEPTOR LAWN SPRINKLER SYSTEM WATER HEATER GAS SYSTEM OUTLETS OUTLETS OVER 5 PER SYSTEM Plan check fee PLUMBING PERMIT ISSUING FEE $ TOTAL FEE Plan check applicant Name Address City Tel. No. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING, I HEREBY CERTIF'r THAT I AM PROPERLY:REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGE4ES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF. AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. t ( SIGNATURE OF PE RMITTEE t /' DISTRICT NO. PRaCESSED BY( h, BUILDING ADDRESS 21275 A bushe s St. LOCALITY NEAREST CROSS ST. Cold OWNER D MAIL 800 N. Tustin ADDRESS CITY Santa Ana TEL. N09 5 3 —0 9 3 2 CONTRACTOR ADDRESS e Q >, $ aX 2247 CITY Laguna Hills TEL NO8 STATE LIC. LICENSE NO. CLASS APPROVALS DATE NSPECTOR'S SIGNATURE UNDER SLAB WORK ROUGH PLUMBING GAS PIPING GAS VENT HOT WATER HEATER PLUMBING FIXTURES GAS TEST UTILITY CO. NOTIFIED FINAL PLAN CHECK VALIDATION PERMIT VALIDATION INDUSTRIAL WASTE APPI