HomeMy Public PortalAbout5706 CLOVERLY AVE_Plumbing__ 76A667 APPLICATION
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DBS 171055 APPLICATION FOR E LUMBING ■ ERMIT
DIVISION OF BUILDING AND SAFETY
Department of Coun�gy
Engineer
County of Los elea BUILDINGJOHN A LAMBIE COTENGINEER ADDRESS
CASSATT D GRIFFIN SUP T OF BUILDING
LOCALITY
FOR APPL
ICAM TO FILL IN NEAREST
CROSS ST
OWNE r ' DISTRICT GROUP (ZONE I READY FOR INSPECTION
MAIL
ADDRES T
4 INDUSTRIAL
CIT TEL NO WASTE APPROVAL
P L UMa INSPECTION RECORD
ADDRESS t
•T TEL NO
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LICENN �.2
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET) @ $1 00 $
BATH TUB @ $1 00
SHOWER @ $1 00
LAVATORY (WASH BASIN) @ $100
i
KITCHEN SINK @ $1 00
DISHWASHER @ $100
LAUNDRY TUB OR TRAY @ $100
CLOTHES WASHER @ $1 00 n
WATER HEATER @ $1 00 (/
GAS SYSTEM @ $100
APPROVALS
DATE INSPECTOR S SIGNATURE
UNDER SLAB WORK
PERMIT $ 1 00 ROUGH PLUMBING
GAS PIPING
TOTAL FEE GAS VENT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER r
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
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WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING PLUMBING FIXTURES
I HEREBY CERTIFY THAT AM P PERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY OS A ELES COUNTY AND STATE OF
CALIFORNIA OR THAT I T LEGAL OWNER OF THE ABOVE U LITY CO NOTIFIED
DESCRIBED RESIDENTIA ROP TY
SIGNATURE
OF PERMITTEEFINAL
JOHN A LAMBIE, COUNTY ENGINEER VALIDATIO ROBERT A WOOD CHIEF PLBG INSPECTOR
CK m 0 CASH
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