HomeMy Public PortalAbout9232 BLACKLEY ST_Plumbing__ ' 76A667AICIE�.8178) 11/76
• ` ' APPLICATION FOR PLUMBING PERMIT
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BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING C a c Y S
NUMBER FIXTURE OR ITEM @ FEE
WATER CLOSET LOCALITY -
�O NEAREST
BATH TUB CROSS ST -
SHOWER OWNER-
LAVATORY MAIL
ADDRESS J
SINK CITY TEL NO
DISHWASHER CONTRACTOR I
CLOTHES WASHER
ADDRESS
SWIMMING POOL RECEPTOR /-
CITY V GG TEL NO
LAWN SPRINKLER SYSTEM STATE 7
1-1
WATER HEATER LICENSE NO J J 7
y �2 3 CLASS 3
GAS SYSTEM OUTLETS
DISTRICT NO GROUP ZONE PRO ED BY
�-v J✓ � ��
OUTLETS OVER 5
5 PER SYSTEM INDUSTRIAL 0.
WASTE APPROVAL O
INSPECTION RECORD V
IOC
7 1020 aV
z
Plan check fee
PLUMBING PERMIT ISSUING FEE$ ,t„L
TOTAL FEE Q
Plan check applicant
APPROVALS DATE INSPE OR 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
LEGAL OWNER OF AND INTE TO RESIDE IN E ABOV SCRIBED RESIDENTIAL
PROPERTY UTILITY CO NOTIFIED
SIGNATURE
OFPERMITTEE FINAL
PLAN'CHECKVALIDATION CK MO CASH PERMITVALIDATI ( CKj Mo CASH