HomeMy Public PortalAbout5461 CLOVERLY AVE_Plumbing__ 76A667A(CE B17B) 11/76 y '1
1APPLICATION FOR'PLUMBING PERMIT �S
BUILDING AND SAFETY DIVI N
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
NUMBER FIXTURE OR ITEM @ FEE
ADDRESS
WATER CLOSET LOCALITY �+^�
BATH TUB NEAREST
CROSS ST
SHOWER OWNER
LAVATORY MAIL
ADDRESS
SINK CITY TEL NO�/`
DISHWASHER CONTRACTOR,,/ y�
CLOTHES WASHER
ADDRESS
SWIMMING POOL RECEPTOR
CITY ✓ � TEL NO
LAWN SPRINKLER SYSTEM
STATE LIC
WATER HEATER LICENSE NO CLASS
ISGROUPP CESS BY
GAS SYSTEM OUTLETS D
3 i� rRICT NO
OUTLETS OVER O �J
5 PER SYSTEM INDUSTRIAL IL
WASTE APPROVAL v
INSPECTION RECORD u
O
d
Yf
Plan check fee
PLUMBING PERMIT ISSUING FEE$
TOTAL FEE
Plan the applicant
APPROVALS DATE INSPECTOR 5 SIGNATURE
Name
UNDER SLAB WORK
Address ROUGH PLUMBING
A
City Tel No GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING HOT 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 PERMITTEE1�7, FINAL
PLAN CHEC LIDA ON CK M Q CASH PERMIT VALIDATION cK M o CASH
947i=SEP 40 5 D 7.5 0 ,&;,
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