HomeMy Public PortalAbout9987 BOGUE ST_Plumbing__ 76A66.7A ICE 617B)- 11/76 11
- I APPLICATION FOR PLUMBING PERMIT f�
BUILDIN D SAFETY DIVISION
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
MBE FIXTURE OR ITEM @ FEE
ADDRESS .r v `�•/ �/
WATER CLOSET l LOCALITY
BATH TUB NEAREST L:CLow/.�
- ,CROSS 5T (�'F � t` LT?
OF pv SHOWER OWNER 'f
LAVATORY MAIL
ADDRESS •
CITY TEL NO
DISHWASHER CONTRACTOR
4 W/v' � L
CLOTHES WASHER
ADDRESS
SWIMMING POOL RECEPTOR
CITY TEL NO
LAWN SPRINKLER SYSTEM
STATE ' LIC
WATER HEATER LICENSE NO CLASS
GAS SYSTEM OUTLETS DISTRICT NOj GROUP NE PAbCESSED Y
OUTLETS OVER
S PER SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD u
09
43
Plan check fee m
PLUMBING PERMIT ISSUING FEE$
TOTAL FEE
Plan check applicant
1 APPROVALS DATE INSPECTOR'S SIGNATURE
Name o l
` UNDER SLAB WORK i =
Address S15o �! ROUGH PLUMBING
City �� 4! Tel.NO vN7 GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAA READ THIS APPLICATION AND STATE GAS VENT `
THATTHE 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 INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL _
PROPERTY UTILITYCO NOTIFIED '
SIGNATURE -
,OF PERMITTEE FINAL',
PLAN CHECK VAL�IDA/QON CK- M Q CASH PERMIT VALIDATION CK'• M O- - 'CASH
3 3 8 r PUG 22 -9 1) 1 3.5 0 ,&S'8
®s