HomeMy Public PortalAbout4811 CAMELLIA AVE_Plumbing__ 76A667A ICE III- 11/76
APPLICATION FOR PLUMBING PERMIT
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
NUMBER FIXTURE OR ITEM ® FEE ADDRESS
WATER CLOSET LOCALITY
NEAREST
BATH TUB CROSS ST.
SHOWER OWNER "
LAVATORY MAIL A
ADDRESS QZ�P�^/v pp
SINK CITY TEL,NO. W11_.3/4:7a�4:
'DISHWASHER CONTRACT R_
CLOTHES WASHER
ADDRESS
SWIMMING POOL RECEPTOR
CITY TEL.NO.,,1,
LAWN SPRINKLER SYSTEM STATEf' J) 9 p ,�J L /(
WATER HEATER LICENSE NO. TP�7 A CLASS t ^d /.
GAS SYSTEM OUTLETS DISTRI NO. GROUP jry ICOCESSE BY
OUTLETSOVER G
5 PER SYSTEM INDUSTRIAL
WASTE APPROVAL V
INSPECTION RECORD R,
0
W
d
N
Z
Plon checkfee
PLUMBING PERMIT ISSUING FEE$ ^7
OTAL FEE
Plan check applicant
APPROVALS DATE INSPECTOR'S SIGNATURE
Name
UNDERSLAB WORK
Address ROUGH PLUMBING
City Tel, No. GAS PIPING
1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT
THAT TNF ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING. HOi 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. UTILITY CO.NOTIFIED
SIGNATURE
OF PERM 11-TEE FINAL
PLAN CHECK.VALIDATION' C,L'1��TRY! �.m.o,A cL0i PERMIT VALIDATION cK. M.O. CASH
C.
9,2 3 cP VIAR b 5D
POLICY HOL.OER:j' 4_�
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POLICY NUMBER: