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APPLICATION FOR PLUMBING PERMIT
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^� COUNTY OF LOS ANGELES BUILDING AND SAFETY w ,
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FOR APPLICANT TOFFILL IN(PRINT OR TYPE) BUILDING
ADDRESS 4833 TAaWedpmwAetrSq6Tfl
NUMBER FIXTURE OR ITEM @ k FEE
r LOCALITY t a
WATER CLOSET 00
NEAREST
BATH TUB v CROSS ST %
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SHOWER OWNER Fairhaven Corp
LAVATORYy 00 MAIL a
ADDRESS
SINK i t i 00 CITY TEL NO
DISHWASHERT
0 CONTRACTOR Dwr`sey Plumbing CO
CLOTHES WASHER 00 ADDRESS
SWIMMING POOL RECEPTOR " ..
CITY La Verne TEL N6599-0828
LAWN SPRINKLER SYSTEM y r
WATER HEATER 1 e 00 LICENSE NO 1 5421 t CLASS B C-36
GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR S SIGNATURE O
OUTLETS OVER t UNDER SLAB WORK _, .
5 PER SYSTEM ROUGH PLUMBING
GAS PIPING
GAS VENT 27 t N
HOT WATER HEATER
PLUMBING FIXTURES t
GAS TEST )-/ i*r"
Plan check fee r UTILITY CO NOTIFIED /
PLUMBING PERMIT ISSUING FEE$ r
TOTAL FEE FINAL �_ av Si) -✓
Pion check applicant
r PLAN CHECK VALIDATION
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Nome
Address
City Tel No e t
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE ! �Q O a 5 A
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES l
AND STATE LAWS REGULATING PLUMBING PERMIT VALIDATION # O O O O o 5
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS F
REQUIRED BY LOS�ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE w 2 — 4300
LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL ;
PROPERTY r C J 10 0641005
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SIGNATURE E
OF PERMITTEE t F 0428-80
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DISTRICT NO P OCE$$E BY,
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INDUSTRIAL
WASTE APPROVAL r
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