HomeMy Public PortalAbout5822 CLOVERLY AVE_Plumbing__ -76A667 -'CE817 5/70 t (�
APPLICATION FOR LUMBING PERMIT
a COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION AUILDING
DDRESS ��vC
JOHN A LAMBIE COUNTY ENGINEER
COLEMAN W JEINKINS SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN PR NT OR TYPE) NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET 1 5014AIL ff
_
BATH TUB 1 50 ADDR �' 'z (�
SHOWER 1 50 CI TEL NO O �6
LAVATORY 1 s0 CONTAACTO
_ SINK 1 50 ADD ty
DISHWASHER 1 50 C TEL NO.?f� /a,1e.
CLOTHES WASHER 1 50 STATE ? CLASS
LIC
LICENSE NO D i! �
SWIMMING POOL RECEPTOR 1 50 DISTRICT NO GR P S^g''�BY
LAWN SPRINKLER SYSTEM 2 00 '5—, '!�p (F-
WATER HEATER 1 50 INDUSTRIAL a
WASTE APPROVAL Q
f GAS SYSTEM OUTLETS 1 50 INSPECTION RECORD
OUTLETS OVER 30
5 PER SYSTEM
z
Plan check fee 25% of above See reverse - -
PLUMBING PERMIT ISSUING FEE 8 00
TOTAL FEE
APPROVALS DATE INSPECTOR 5 SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
GAS VENT 0
City Tel No
HOT WATER HEATER
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST
PLUMBING _
+ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED
LICENSED AS REOUIRED BY LOS ANGELES COUNT HD STATE OF �� p
CALIFORNIA OR HA THE LEGAL O NER D INTEND TO 9
RESIDE IN THE E CRIBED REBID IAL OP Y ,J/J FINAL w
SIGNATURE f � JACK R ALLEN, SUPERVISIN EC ANICAL ENG'R
OF PERMITTEE
PERMIT VALIDATION CK
M o C ASH
PLAN CHECK VALIDATION CK M o CASH
LrtLCO '— 7 _, lInR 2 7 �77 D/ 4.7 5, N