HomeMy Public PortalAbout5622 CLOVERLY AVE_Plumbing__ DBS 17 12 54 APPLICATION FOR PLUMBING PERMIT
DIVISION OF BUILDING AND SAFETY
` Department of County Engmeer
County of Los Angeles
WM J FOX, COUNTY ENGINEER BUILDING Z� 11
� _ADDRESS �CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY FOR APPLICANT TO FILL IN cNEAR sT7OWNER DISTRICT NO GROUP �/ NREADY FOR INSPECTION
MAIL /rel!
ADDRESS 4c�.
INDUSTRIAL
CITY rr� TEL NO WASTE APPROVAL
PLUMBER l�L� INSPECTION RECORD
ADDRESS O dAj
CITY d.LUCA.: TEL //NO t7
LICENSE NO 61
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET) $
BATH TUB
SHOWER
LAVATORY (WASH BASIN)
KITCHEN SINK
DISHWASHER
LAUNDRY TUB OR TRAY
CLOTHES WASHER
TOTAL NO Cel 080 APPROVALS
DATE INSPECTOR S SIGNATURE
GAS SYSTEM�OUTLETS Q 700 I t
UNDER SLAB WORK
WATER HEATER @1 00
ROUGH PLUMBING 15 l 0,44 1,
PERMIT $ 1 OO GAS PIPING V
TOTAL FEE GAS VENT
I HEREBY ACYNOWLEDGE THAT IHAVE READ THIS APPLICATION HOT WATER HEATER
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES
PLUMBING • w- N
1 HEPEBY CERTIFY THAT I AH PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNT AND STATE OF UTILITY CO NOTIFIED U
CALIFORNIA OR 1HAT 1 AM THE LEGAL OW NE OF THE ABOVE
DESCRIBED RESIDENTIAL PROP�.F2�Y . '
SIGNATURE ►��v/t-
OF PERMITTEE FINAL \t k
WILLIAM J FOX, COUNTY ENGINECR VALMATION
,'G,1 7-5 2 is ` 2 1 3
BY
DEPUTY