HomeMy Public PortalAbout5740 CLOVERLY AVE_Plumbing__ ,76A6694 (.Cr- 8176) -4/77 "fl
APPLICATION FOR PLUMBING PERMIT yILJI'
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING n
NUMBER FIXTURE OR ITEM ® FEE ADDRESS
LOCALITY
WATER CLOSET
BATH TUB 2 NEAREST
J CROSS ST
SHOWER 3 OWNER
ZMAIL
LAVATORY" ADDRESS o 3
/ SINK CITY TEL NO C
DISHWASHER I
CONTRACTOR �lt�
CLOTHES WASHER „, I ”
ADDRESS d;q /
SWIMMING POOL RECEPTOR
CITY TEL NO
LAWN SPRINKLER SYSTEM STATE p c LIC
t WATER HEATER 3 LICENSE NO Z / D f CLASS t� 3SQ
GAS SYSTEM OUTLETS DISTRI ryQ GROUP ZONE ROCESS BY
_ r
OUTLETS OVER -r CD
5 PER SYSTEM INDUSTRIAL V
WASTE APPROVAL
INSPECTION RECORD �
U
W
CIL.
C17
Plan check fee
PLUMBING PERMIT ISSUING FEE$
TOTAL FEE
Plan check applicant
APPROVALS DATE INSPECTOR S SIG.NATURE
Name
UNDER SLAB WORK
Address ROUGH PLUMBING
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 RESID IN THE ABOVE DESCRIBED RESIDENTIAL
PROPERTY UTILITY CO NOTIFIED
SIGNATURE /
OF PERM ITTE e__e FINAL
SNCOMPEcNS)koTIC*s PERMIT VALIDATION cK Mo CASH
6 SIL-1-AUG L) 4
POLICY HOLDER; -
POLICY NUMBER: )2."C