HomeMy Public PortalAbout9410 BLACKLEY ST_Plumbing__ 0'76 A 667 - E 817 7-69
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APPLICATION FOR PLUMBING PERMI
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ADDRESS J
JOHN A LAMBIE, COUNTY ENGINEER
ING
COLEMAN W JENKINS SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN (PR NT OR TYPE) NEAREST
CROSS ST f
NUMBER FIXTURE OR ITEM EACH FEE
y
WATER CLOSET 1 50 OWNER
MAIL �y
BATH TUB 1 so ADDRESS C/
SHOWER 1 50 CITY TEL NO
LAVATORY1 50
CONTRACTOR &'
SINK 1 50 ADDRESS 1
Ak
DISHWASHER 1 50 CITY TEL NO
CLOTHES WASHER 1 50 STATE LIC
LICENSE NO CLASS
SWIMMING POOL RECEPTOR 150 DISTRICT NO GR P ZONE R C ED BY
LAWN SPRINKLER SYSTEM 2 00 J/` r i
WATER HEATER , r^ INDUSTRIAL O
WASTE APPROVAL
GAS SYSTEM OUTLETS 1 50 INSPECTION RECORD
OUTLETS OVER 30
5 PER SYSTEM
W
d
N
z
t;
Plan check fee 2S% of above See reverse
PLUMBING PERMIT ISSUING FEE 8 3 00
TOTAL FEE
APPROVALS DATE INSPECTOR SSIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
GAS VENT
City Tel NO HOT WATER HEATER
I 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 GAS TEST
PLUMBING
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF AND INTEND TO
RESIDE IN THE ABOVE DESCRIBE �RE�SIDETL PROP TY FINAL '-
SIGNATURE JACK R. ALLEN, SUPERVISIN HANICAL ENG'R
OF PERMITTEE
PERMIT VALIDATION c K M O CASH
PLAN CHECK VALIDA IO CK M O CASH
.0 6 1,7 14 MAY 19 4.75- 1::
76A667A VIE 8178) 11/76 1' !
APPLICATION FOR PLUMBING PERMIT �b
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING //° dry
NUMBER FIXTURE OR ITEM ® FEE ADDRESS ,(( O0
WATER CLOSET 0 LOCALITY p �' ��opp�NEAREST �
BATH TUB U CROSS ST ale
SHOWER OWNER �I p QAIL
Be
LAVATORYUC) ADDRESS
SINK CITY (g�_p TEL NO alg& 713
DISHWASHER CONTRACTOR IV
CLOTHES WASHER
ADDRESS
SWIMMING POOL RECEPTOR
CITY TEL NO
LAWN SPRINKLER SYSTEM
STATE LIC
WATER HEATER LICENSE NO CLASS
GAS SYSTEM OUTLETS DISTRICT NO GROUP 7QNE ROCESSEQBY
OUTLETS OVER
5 PER SYSTEM INDUSTRIAL v 916
WASTE APPROVAL V
INSPECTION RECORD / u
ITSa
Plan check fee _
PLUMBING PERMIT ISSUING FEE$
TOTAL FEE
Plan check applicant
APPROVALS DATE INSPECTORS SIGNATURE
Name G` A.11 v
UNDER SLAB WORK
Address 1,010 r— X §- ROUGH PLUMBING
City ^� Tel Na clGAS PIPING A
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 'FEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL f
PROPERTY UTILITY CO NOTIFIED
SIGNATURE C
OF PERMITTEE
PLAN CHECK VALIDATION CK M O CASH PERMIT VALIDATIONCK M Q CASH
0 0 8 JUN 14 5 D 1 3,5 G -&
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