HomeMy Public PortalAbout9180 JAYLEE DR_Plumbing_6/28/1974_water heater 76A667 (CE-817) - 5/73 0
APPLICATI I4I F R P'L.UMB1NG PERM-1
sA
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND.SAFETY DIVISION '
MAKE CHECKS PAYABLE TO:, i, r. ADC)RESS
9/ 2 6
Ne-
HARVEY T. BRANDT, COUNTY ENGINEER,. .
•LOCALITY'
FOR APPLICANT TO FILL.IN (PRINT OR TYPE) NEAREST ® J
" CROSS ST., !/�• J
NUMBER FIXTURE OR ITEM @ FEE
I . ,.,OWNER. ',�� - •
WATER CLOSET 1,75
MAIL "
BATH TUB 1,75 ADDRESS
SHOWER 1,75CITY �. EL.
LAVATORY .1,75 CONTRACTOR
kIN- kc
SINK 1.75 ADDRESS/D
DISHWASHER 1.75 CITY
CLOTHES WASHER 1,75 STATE LIC .,
LfCENSE N'0 `= CCASS
SWIMMING POOL RECEPTOR- 1,75
DISTRICT NO. GROUP NE FR SSED BY
LAWN SPRINKLER SYSTEM )1,75 a f
WATER HEATER 1,75 INDUSTRIAL
WASTE APPROVAL y:
GAS SYSTEM OUTLETS 1.75 - d
INSPECTION RECORD
OUTLETS OVERF7i. v
5 PER SYSTEM 90 PRY, rAI •_ l.1-7 Jl,9 .rQ•`L? O
Z
Plan Check fee See Reverse
PLUMBING PERMIT ISSUING FEE $ 3 ob
TOTAL FEE
- APPROVALS DATE INSPECTOR'S SIGNATURE
Plan Check applicant UNDER SLAB WORK
Name �..� ROUGH PLUMBING
Address 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' v
WITH ALL COUNTY 'ORDINANCES AND STATE LAWS REGULATING
PLUMBING. GAS TEST
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED
LICENSED AS REOU I RED BY LOS ANGELES COUNTY AND STATE OF
CALI FORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO sl
RESIDE I-N THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. FINAL •�� `�"
SIGNATURE
OF PERMITTEE �..
PERMIT VALIDATIONcK. M.0. CASH
.PLAN CHECK VALIDATION CK. M.O. CASH
7 8 O ,JUN z-a` 510 4.7 5 A