HomeMy Public PortalAbout9022 JAYLEE DR_Plumbing_11/13/1979_water and gas fixtures 76A667t-,�
CE 817(REV.11/78)*APPLICATION ;WFR PLU IWB ING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
(,�
NUMBER FIXTURE OR ITEM @ FEE ADDRESS __e
/ WATER CLOSET (t LOCALITY
NEAREST
BATH TUB CROSS ST.
SHOWER OWNER
LAVATORY (/ MAIL -JADDRESS J C e•e
SINK CITY Ca L i- e / TEL.NO.
DISHWASHER CONTRACTOR v�✓
CLOTHES WASHER ADDRESS
SWIMMING POOL RECEPTOR
CITY �� J� VII"I" TEL.NO. kt/j "
LAWN SPRINKLER SYSTEM
STATE LIC,
WATER HEATER
LICENSE NO. CLASS j
GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR'S SIGNATURE
OUTLETS OVER UNDER SLAB WORK Mae.
5 PER SYSTEM ROUGH PLUMBING
GAS PIPING V
GAS VENT d=
HOT WATER HEATER
F�
PLUMBING FIXTURES 1 �j
• �� GAS TEST ZZ--W
( (e 7 Q y �-
Plan check fee UTILITY CO.NOTIFIED
PLUMBING PERMIT ISSUING FEE$
TOTAL FEE FINAL `
Plan check applicantPLAN CHECK VALIDATION
;j?h At Mimi
Name
Address r f^e
City b u it d Tel.No.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE 7 b 9.7 A.
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES 75
AND STATE LAWS REGULATING PLUMBING. PERMIT VALIDATION
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS 000Q,o5
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 RESIDENTIAL 2 O - 2200
PROPERTY.
- D - 2200c
SIGNATURE '
OFPERMITTE •� 1, 1 3. 79
DIST C��� POCESSED BY
INDUSTRIAL
WASTE APPROVAL