HomeMy Public PortalAbout9168 JAYLEE DR_Plumbing_12/13/1977_gas syst 76A667A (CE 8178) -4/77
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
NUMBER FIXTURE OR ITEM ® FEE ADDRESS —`6
WATER CLOSET LOCALITY' f n5 T
NEAREST v�
BATH TUB CROSS ST. k%C>H
SHOWER OWNER
DeL:06
MAIL _ '
LAVATORY ADDRESS /�F�
SINK CITY pi� TEL.'
DISHWASHER CONTRACTOR
CLOTHES WASHER
ADDRESS
SWIMMING POOL RECEPTOR
CITY TEL.NO. --
LAWN SPRINKLER SYSTEM
STATE LIC.
WATER HEATER LICENSE NO. CLASS
GAS SYSTEM OUTLETS 0L D T CT NO. GROUP ZONE PR SSE B
a
OUTLETS OVER O � 14—(� O
5 PER SYSTEM INDUSTRIAL V
WASTE APPROVAL LL'
INSPECTION RECORD
U
Lu
S_!h - 72;-
Plan check fee
PLUMBING PERMIT ISSUING FEE$ �Q
TOTAL FEE rj'p
I
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 GAS VENT
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER
I HEREB�OF.
ERTIFY THAT I AM PROPERLY REGI RED AND/OR LICENSED AS PLUMBING FIXTURES
REQUIRED BY ANGELES COUNTY.AND STATE O CAJIFORNIA OR THAT I AM THE GAS TEST
LEGAL OWNER a
TO SIDE IN THE ABO E DESCRIBED RESIDENTIAL
PROPERTY. - UTILITY CO.NOTIFIED
SIGNATURE
OF PERMITTE FINAL ' 7
PLAN CHECK VALIDATION K _ M.O. CASH PERMIT VALIDATION CK. M.O. cnsli ��
59�DEC 5 fl 7.5 C.)