HomeMy Public PortalAbout4828 CLOVERLY AVE_Plumbing__ 76A667 CE '817 2 62 /'&Y�v
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS Y
WILLIAM A JENSEN SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN HOA ss ST
NUMBER FIXTURE OR ITEM EACH FEE
OWNER ol
WATER CLOSET 51 25 S� MAIL
BATH TUB 125 � ��
ADDRESS
CITY TEL NO
SHOWER 1 25
LAVATORY 125 CONTRALTO
SINK 125 ADDRESS
DISHWASHER 1 25 CITY v/ZOv TEL NO -SSL
LAUNDRY TUB 125 CONTRACTOR S / STATE
REGISTRATION NO Q 6 COUNTY ❑
CLOTHES WASHER 1 25 DIST ICT N GROUP ZONE P SSED BY
/ WATER HEATER 150
1 -4-0 ted-
i
GAS SYSTEM OUTLETS 1 50 / �'1) INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD
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W
aS� AD
APPROVALS DATE INSPECTOR
,SSS/IIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK (,2ylQ
ROUGH PLUMBING
TOTAL FEE ` 7-:5 GAS PIPING
W51",
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER 4^
PLUMBING
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES a'
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF AND INTEND TO n D
RESIDE IN THE ABOVE ESCRIBED RESIDENTIAL
-�P'�R,�OP,�ERRT_YUTILITY CO NOTIFIED
LGNATURE
F PERM TTEE � I A •'
FINAL
r � �
VALIDATION ROBERT A� WOOD
cK M O CASH SUPERVISING MECHANICAL ENG R
5 5 7 8 1 OCT 1 6 5 0 13.75-