HomeMy Public PortalAbout4822 CAMELLIA AVE_Plumbing__ 76AG67 ICE-0171 - II75 �A p/ F ,
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO: BUILDING
ADDREIN -
P, ALI
HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY
S FOR APPLICANT TO FILL IN (PRINT OR TY PEI NEAREST
NUMBER FIXTURE OR ITEM @I FEE CROSS ST.
WATER CLOSET
OWNER
1 MAIL -
f _ BATH TUB 3 O ADDRESS Q
SHOWER CITY Qr. _ _C TEL. NO. � _
1 LAVATORY 2.10 .0O CONTRACTOR
SINK V ADDRESS
DISHWASHER 2. 0 CITY TEL. NO.
CLOTHES WASHER2. 0 STATE - LIC
SWIMMING POOL RECEPTOR 2. 0
LICENSE
DISTRI NO. CLASS
NO. R UP ^ ZON OCESSED BY
LAWN SPRINKLER SYSTEM 2 0 - iI O�
WATER HEATER 2 0 INDUSTRIAL tr
WASTE APPROVAL
GAS SYSTEM OUTLETS 2. 0 INSPECTION RECORD
OUTLETS OVER CC ��ryw 1
5 PER SYSTEM ���Z7 � WY C(.j�y upz&z
d
Z13
Plan check fee Sea R.Yerse -
PLUMBING PERMIT ISSUING FEE $
TOTAL FEE 1315— 0 -
APPROVALS DATE INSPECTOR 5 SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
" Addre55 GAS PIPING
City Tel. NO. GAS VENT
HOT WATER HEATER
I HEREBY ACKNOWLEDGE THAT I HAVE READ .THIS APPLICATION
.AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING_FIXTURES
WITH ALL COUNTY 'ORDINANCES AND STATE LAWS REGULATING GAS TEST
PLUMBING.
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED
f LICENSEDAS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO p
RESIDE IN THE ABOVEDESCRIBED RESIDENTIAL PROPERTY. FINAL Z 70
SIGNATURE '
OF PERMITTEE
- PERMIT VALIDATION crc. M,o: CASH
PLAN CHECK VALIDATION CK. M.D. CASH ,,e
00.2' �V 45 5 v 1 6.!50 A-