HomeMy Public PortalAbout9647 BROADWAY_Plumbing__ 76A667,t � 2S
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APPLICATION FORUMBIN IT
COUNTY OF LOS ANGELES � BUILDING A Y
FORAPPLICANT TO FILL IN IPRINTOR TYPEI BUILDING
ADDRESS72clkloA i-IR
NUMBER FIXTURE OR ITEM FEE
WATER CLOSET
LOCALITY !w I7 CLT
I � NEAREST
BATHTUB CROSS ST. — G 'L 4,L/D
( SHOWER OWNER
LAVATORY MAIL
ADDRESS -
SINK CITY TEL,NO,
DISHWASHER CONTRACTOR T CLO hl,Sr
CLOTHES WASHER ADDRESS'K-:3yo
SWIMMING POOL RECEPTOR
CITYG T}. TEL.
LAWN SPRINKLER SYSTEM STATE a LIC.
WATER HEATER LICENSE NO. CLASS �) _
GAS SYSTEM OUTLETS A P VACS DATE _ INSPECTOR'S SIGNATURE
OUTLETSOVER UNDER WORK 6116 /J'°
5 PER SYSTEM ROUGH PLUMBINGr
C6
GAS PIPING -1 6 UF, ..G O
u
GAS VENT &
HOT WATER HEATER Q
PLUMBING FIXTURES
GAS TEST
Plan check fee UTILITY CO.NOTIFIED V a
PLUMBING PERMIT ISSUING FEE$ _J
TOTAL FEE / 616 FINAL
AN CHECK VALIDATIO V
PL
Plan check applicant V LAI
Nome
Address Sw� , 0 R 9 A
City A L F ` Tel-No. , -i L# o 0 o a o 5
HEREBY ACKN WLEOGE THAT I HAVE READ THIS APPLICATION AND STATE (�
THATTHE ABOVE ISCOPRECTANO AGREE TO COMPLYW17H ALL COUNTY ORDINANCES e 1 9. 00
AND STATE LAWS REGULATING PLUMBING. PERMIT VALIDATION 9- 005
T
I HEREBY CERTIFY THAT I AM PROPERLY REG15TERED AND/OH LICENSED AS .0 -/, 0 0 5
REDO IF
ED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE
LEGAL OWNER OF,AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL 0 G J. 1 O;O 0
PROPERTY
SIGNATURE C O
OF PERMITTEE
DISTRICT NO O ESSED 8 n
INDUSTRIAL
WASTE APPROVAL