HomeMy Public PortalAbout5611 CAMBURY AVE_Plumbing__ 1
� ]6A66] (CE-817) - 6/73 all
� t I �, I µll C / Tq
APPLICA ION FOR,PLUMBING PERMIT
COUNTY OF LOS ANGELES - L' CH
DEPARTMENT OF COUNTY,ENGINEER' .
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO: BUILDING
ADDRESS/
HARVEY-T: BRANDT, COUNTY ENGINEER
LOCALITY / Cm /•' 'FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST
CROSS•ST..r
NUMBER FIXTURE OR ITEM @ FEE
WATER CLOSET 1.75 7 OWNER
.MAIL , ,.
1
BATH TUB 7.75 ADDRESS 0l
SHOWER 1.75 CITY- r- r- TEL."NO.'5)& 40(
,LAVATORY 1.75 CONTRACTOR
SINK1.75 ADDRESS
DISHWASHER 1.75 .CITY, TEL. NO. _j-L-/0, 0
CLOTHES WASHER - 1.75 STATE ) QQQ �/ LIC
.LICENSE`NO, _n Q' /'a - CLASS" dy
SWIMMING POOL RECEPTOR -1,75
'DISTR�C,T NO. GROUP E - PROC SSED' Y
LAWN SPRINKLER SYSTEM 1.75 �r /� {]-
11 V d� L '-
WATERHEATER - 1.75 _ ��� INDUSTRIAL y
WASTE APPROVAL _ a
GAS SYSTEM -OUTLETS 1.75 INSPECTION RECORD"; �U
OUTLETS OVER -'
5.PER SYSTEM .30
- H
_ _ V
t W
d
11 y
Plan check fee - See Reverse
PLUMBING PERMIT ISSUING FEE $ 3 '00 -
TOTAL FEE
APPROVALS DATE is PCCToe's SIGNATURE'
Plan Check applicant UNDER SLAB WORK
1
Name ROUGH PLUMBING '!t
Address GAS PIPING.
City Tel. No. GAS VENT
HOT WATER HEATER
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVEIS 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 REGO I RE BY LOS ANGELES COUNTY AND STATE OF ,
CALIFORNIA OR THAT l'Am THE LEGAL OWNER OF, AND INTEND TO
RESIDE'�IN THE ABOVE DEG
CRIBEO SID TI PROPER TT. FINAL . �7K.
Al
SIGNATURE �,^ �~
OF PERMITTEE
PERMIT, VALIDATION cases
PLAN CHECK VALIDATION arc. M.D. CASH .75ed