HomeMy Public PortalAbout5941ALESSANDRO AVE_Plumbing (4) 76A667 (CM 817) 1/75
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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING ` �
MAKE CHECKS PAYABLE TO ADDRESS
HARVEY T BRANDT COUNTY ENGINEER LOCALITY
FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST '
CROSS ST
NUMBER FIXTURE OR ITEM @ FEE
WATER CLOSET
2 00 OWNER
MAIL
BATH TUB 2 00 ADDRESS
SHOWER 2 00 CITY f TEL NO �� Jq
LAVATORY 200 CONTRACTOR 1
SINK 200 ADDRESS GLS
A
DISHWASHER 200 CI; EL NO
CLOTHES WASHER 2 00 STATE LIC
SWIMMING POOL RECEPTOR 200 LICENSE NO � CLASS
DISTRICT NO GROUP ZONE CESSE BY
LAWN SPRINKLER SYSTEM 200
WATER HEATER 2 00 INDUSTRIAL
l WASTE APPROVAL d
GAS SYSTEM OUTLETS 2 00 U am
INSPECTION RECORD c.)
OUTLETS OVER
5 PER SYSTEM 30
CD
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W
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Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEE $
TOTAL FEE �
Plan check applicant 7 APPROVALS DATE INSPECTOR $ SIGNATURE
UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING ,
City Tel No GAS VENT
HOT WATER HEATER
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
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 REQUIRED BY LOS ANGELES COUNTY ND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO
RESIDE IN THE ABOVE DESCRIBEDRESIDENTIAL PR RTY FINAL 4-77 µ
SIGNATURE ✓ ((��1�{/��/JJ//
OF PERMITTEE
PERMIT VALIDATION CK M O CASH
PLAN CHECK VALIDATION CK M 0 CASH
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