HomeMy Public PortalAbout5760ALESSANDRO AVE_Plumbing (2) 76A667A ICE 6176) 11/76
�R APPLICATION FOR PLUMBING PERMIT
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN(PRINT OR TYPE) - BUILDING 01
NUMBER FIXTURE OR ITEM Q FEE ADDRESS
WATER CLOSET LOCALITY
BATH TUB NEAREST
ST
SHOWER OWNER
LAVATORY MAIL
ADDRESS
SINK CITY TEL NO
DISHWASHER CONTRACTOR
CLOTHES WASHER ADDRESS 6 Q
SWIMMING POOL RECEPTOR CITY TEL NO Z/,
LAWN SPRINKLER SYSTEM STATE LIC
WATER HEATER liiiiiE NO �p CLASS
GAS SYSTEM OUTLETS DISTRICT NO GROUP ZONE I PRO E ED BY
OUTLETS OVER
5 PER SYSTEM INDUSTRIAL
WASTE APPROVAL u
INSPECTION RECORD w
0
O.
Vf
Z
Plan check fee
PLUMBING PERMIT ISSUING FEE$ ?
TOTAL FEE S
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 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE GAS TEST �n 77 �,�- --�-•-�
LEGAL OWNER OF AND INTEND T SIDE IN THE ABOVE DESCRIBED RESIDENTIAL 1 i
PROPERTY UTILITYCO NOTIFIED
SIGNATURE U Z^ /
OF PERMITTE FINAL /
PLAN CHECK VALIDATION CK M 0 CASH PERMIT VALIDATION CK M o CASH
9l 5r-_ + N 6 5 d 7i50 �
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