HomeMy Public PortalAbout5223ALESSANDRO AVE_Plumbing (5) CE 81 (7
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CE 817(REV 6/78)
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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
C Tp�J
NUMBER 1 FIXTURE OR ITEM ® FEE ADDRESS
WATER CLOSET LOCALITY
41,
NEAREST
BATH TUB CROSS ST
SHOWER OWNER
LAVATORY MAIL ESS
ADDR
SINK CITY TEL NO
DISHWASHER CONT
PAr
CLOTHES WASHER ADDR
SWIMMING POOL RECEPTOR GRAND AVE
CITY T IN & D
LAWN SPRINKLER SYSTE
STATE i °
WATER HEATER A/1 LICENSE NO CLASS
GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR S SIGNATURE
OUTLETS 0,1®R ,' UNDER SLAB WORK
5 PER Sy 1
ROUGH PLUMBING �
GAS PIPING 0
GAS VENT 1 v
99
HOT WATER HEATER " 0
PLUMBING FIXTURES
GAS TEST
Plan check fee UTILITY CO NOTIFIED
PLUMBING PERMIT ISSUING FEE$
TOTAL FEE FINAL
Plan check applicant PLAN CHECK VALIDATION
r
Name
Address
City Tel No
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE p Q Q p n
A
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES L V 8 U
AND STATE LAWS REGULATING PLUMBING PERMIT VALIDATION
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS # 0 O O O O 5
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AMti HE
LEGAL OWNER OF AND I THE ABOVE DESCRIBED RESIDENTIAL 2 0 0 1 000
Y
SIGNATURE 100 /0 o 1 "Q
"Q O U
DISTRICT O� PRO ESSED BY
INDUSTRIAL ' O
WASTE APPROVAL