HomeMy Public PortalAbout9059 ACASO DR_Plumbing_8/31/1972 q*EE817)-8-71}' APPLICATION FOR PLUMBIN , PERMI
COUNTY OF LOS ANGELES °
DEPARTMENT OF COUNTY ENGINEER BUILDING //•, p �
BUILDING AND SAFETY DIVISION ADDRESS V / Ir', (j p
` LOCALITY
FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST
NUMBER FIXTURE OR ITEM @ FEE CROSS ST ,�j
OWNER bL .b l�
WATER CLOSET 1 75
MAI L
BATH TUB 1 75 ` ADDRESS tj
SHOWER 1 75 CITY I—S- TEL NO
LAVATORY 1 75 CONTRACTOR o
SINK 1 75 ADDRESS I r )
DISHWASHER 1 75 CITY n k, TEL NO
CLOTHES WASHER 1 75 STATE LIC
SWIMMING POOL RECEPTOR 1 75 LICENSE NO CLASS
DISTRICT N GROU ON ROCESSED BY
LAWN SPRINKLER SYSTEM 1 75
WATER HEATER 1 75 INDUSTRIAL - d
WASTE APPROVAL 0
.GASoSYSTEM OUTLETS 1 75 INSP CTION RECORD V
OUTLETS OVER
5 PER SYSTEM 30 Z 7 Z (/ 12" 0
W
d
` Z
~Plan check fee See reverse
PLUMBING PERMIT ISSUING FEE $ 3 00
TOTAL FEE inrn
APPROVALS DATE INRVECTOR S SIGNATURE
Plan check applicant UNDER SLAB WORK
Name l7b�- ROUGH PLUMBING
Address 076, 6 GAS PIPING
City _ Tel NO GAS VENT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION' HOT WATER HEATER
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING �v
PLUMBING GAS TEST -
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED y If
1
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF '
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO .�
RESIDE IN THE ABOVE DESCRIBED ESIDENTIAL PROPERTY FINAL ~
SIGNATURE
OF PERMITTEE
PERMIT VALIDATIO K • M o cnsH
'S PLAN CHECK VALIDATION CK M 0 CASH
�.,�c, 7-1.9 A 9-* AM 31 5 1-0:00-,1�.