HomeMy Public PortalAbout9422 BLACKLEY ST_Plumbing__ 7(;A667A ICE,817F)- 11,76
APPLICATION FOR PLUMBING PERMIT
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN(PRINT OR TYPE' BUILDING,
VL rV6FR J --FIXTURE UR ITEM v—� FEE ADDRESS
✓LATER CLOSET � LOCALITYNEAREST
f `; BATH. CROSS ST
_—
SrlOWER OWNER
u4V ATORY MAIL
ADDRESS
I 5'^IK CITY � TEL NO.
;SH WASHER CONTRACTOR
CLOTHES WASHER
ADDRESS
SWIMMING POOL RECEPTOR
-
CITY TFL,NO.
LAWN SPRINKLER SYSTEM
STATE UC.
WATER HEATER LICENSE NO. CLASS
SYSTEM OUTLETS DISTRICT NO. ! GROUP ZONE PROCESSED BY
OUTLETS VER
5 PER
YS EM INDUSTRIAL V
WASTE APPROVAL
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INSPECTION RECORD --8
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Plan check fee - g
PLUMBING PEPMIT ISSUING FEE$ _ a-
TOTAL FEE
Plar check appl,c m _
APPROVALS DATE INSPECTOR'S SIGNATURE
Name
UNDER SLAB WORK
Address ROUGH PLUMBING
City Tel.No. GAS PIPING
!HERE9Y ACKNOWLEDGE THAT i HAVE READ.THIS APPLICATION AND STATE GAS VENT
THATTHE ABOVE IS CORRECT AND AGREE TOCOMPI.Y 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 LDS ANGELES COUNTY AMD STATE OF CALIFORNIA OR THAT 1 AM THE GAS TEST
_LEGAL OWNER OF_A_ND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL
PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE
OF PERMITTEE FINAL
PLAN CHECK VALIDATION CK M O. CASH i PERMIT VALIDATION CK. -';;Pm.ol CASH
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