HomeMy WebLinkAbout150376A6671i (CE 6¢71?) - 4/77
APPLICATION FOR PLUMBING PERMIT
BUILDING AND SAFETY DIVISION
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FOR APPLICANT TO FILL IN (PRINT OR TYPEI
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BUILDING
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NUMBER FIXTURE OR ITEM Q
FEE
ADDRESS
WATER CLOSET
LOCALITY
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-TJIVIIERSCABWORK ---- - -
NEAREST
BATH TUB
CROSS ST.
SHOWER
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OWNER
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LAVATORY
-
MAIL
GAS VENT
...THAT ZHE.ASOYE JSLORRFGia1 EEiO COM WfT'H'AtL COUNT' ORDINANCES"
ADDRESS
SINK
CITY
DISHWASHER
Y ISTERED AND/OR LICENSED AS
CONT CT
L
CLOTHES WASHER
F CALIFORNIA OR THAT I AM THE
GAS TEST
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LEGAL OWNER OF D 1 ND TO RESIDE
ABOVE DESCRIBED
ADDR
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SWIMMING POOL RECEPTOR
UTILITY Co. NOTIFIED
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SIGNATU
CITY
LAWN SPRINKLER SYSTEM
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STATE
LICENSE NO
WATER HEATER
CK. M.O. CASH
PERMIT VALIDATION
CK. O. CASH
GAS SYS TLETS
DISTRICT NO.
C
OU TS ER
R TE
INDUSTRIAL
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WASTE APPROVAL
TEL. YO.
TEL. NO.
LIC.
CLASS rC
INE PROCESSED
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INSPECTION RECORD
Plan check fee
PLUMBING PERMIT ISSUING FEE b �"V G'� "5" 3-'' -�!!A
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TOTAL FEE _
Plait check applicant
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APPROVALS
DATE INSPECTOR'S SIGNATURE
Nome
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-TJIVIIERSCABWORK ---- - -
Address
ROUGH PLUMBING
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-City--
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.GAS PIPING-
-
- 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
AN
GAS VENT
...THAT ZHE.ASOYE JSLORRFGia1 EEiO COM WfT'H'AtL COUNT' ORDINANCES"
AND STATE LAWS REGULATI PLUM ING.
HOT WATER HEATER
I HEREBY CERTI THAT M PROPE
Y ISTERED AND/OR LICENSED AS
PLUMBING FIXTURES
I �•
REQUIRED BY LOS ELES UNTY AND S
F CALIFORNIA OR THAT I AM THE
GAS TEST
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LEGAL OWNER OF D 1 ND TO RESIDE
ABOVE DESCRIBED
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PROPERTY-
UTILITY Co. NOTIFIED
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SIGNATU
OF PER
PLAN CHECK VALIDATION
CK. M.O. CASH
PERMIT VALIDATION
CK. O. CASH
8 1503 4 2178
5 16.0 0
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