HomeMy Public PortalAbout5940ALESSANDRO AVE_Plumbing 76A887AE14 817JJ 4/77
APPLICATION FOR PLUMBING PERMIT L•1u�1
BUILDING ND SAFETY DIVISIO
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING 1
NUMBER FIXTURE OR ITEM ® FEE ADDRESS
WATER CLOSET LOCALITY LZ
BATHTUB NEAREST
CROSS ST
SHOWER OWNERf� a >
LAVATORY MAIL
ADDRESS 0
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SINK CITY TEL NO
DISHWASHER CONTRACTOR
CLOTHES WASHER 45 AL
ADDRESS P7
SWIMMING POOL RECEPTOR
CITY �� `. L NO
LAWN SPRINKLER SYSTEM STATELIC
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WATER HEATER LICENSE NO VJ — CLASS
GAS SYSTEM ! OUTLETS DISTRICT NO7707 UP 1 E PROC ED B
OUTLETS OVER 1- 3 <1O
5 PER SYSTEM INDUSTRIAL V
WASTE APPROVAL
INSPECTION RECORDA CD
U
W
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v
Plan check fee
PLUMBING PERMIT ISSUING FEE$
TOTAL FEE
Plan check applicant
Name APPROVALS DATE INSPECTOR S SIGNATURE
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 CERT I AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES
REQUIRED BY LOS A LE COUNTY AND STATE CA IFORNIA OR THAT I AM THE GAS TEST
LEGAL OWNER OF I END TO RESIDE IN T E D CRIBED RESIDENTIAL
PROPERTY UTILITY CO NOTIFIED
SIGNATURE
OF PERIVI FINAL
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PLAN CHECK VALIDATION�� ���cK M o1��cnsH��� PERMIT VALIDATION CK M o CASH
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0 5 8 AUG 2 5 D 1 3 v A�
POL(CY HOL DER
POLICY NUMBER C� )CY I °9 � ��-