HomeMy Public PortalAbout6053 CLOVERLY AVE_Plumbing__ 76,A,667A ~ � --
CE 817(REV.11/78)
APPLICATI N OR P.L BI G PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING O
b �/
NUMBER FIXTURE OR ITEM � FEE ADDRESS
LOCALITY /a b WATER �-
CLOSET NEAREST
BATH TUB CROSS ST.
SHOWER OWNER
LAVATORY MAILADDRESS
SINK CITY 2Cry TEL.N
DISHWASHER CONTRACTOR
CLOTHES WASHER ADDRESS Al
SWIMMING POOL RECEPTOR
CITY NO.
LAWN SPRINKLER SYSTEM STATE LIC.
WATER HEATER LICEN$b�Pa CLASS
GAS SYSTEM v OUTLETS APPROVALS DATE INSPECTOR'S SIGNATURE
OUTLETS OVER UNDER SLAB WORK
5 PER SYSTEM ROUGH PLUMBING d
GAS PIPING 0
GAS VENT �.
HOT WATER HEATER
PLUMBING FIXTURES
GAS TEST tn
Plan check fee UTILITY CO.NOTIFIED
PLUMBING PERMIT ISSUING FEE$ J
TOTAL FEE FINAL
Plan check applicant PLAN CHECK VALIDATION
Name
Address
City Tel.No. ;29725A
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES # O O O O O 5
AND STATE LAWS REGULATING PLUMBING. PERMIT VALIDATION '
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS 2 O O 1 0.00
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE '
LEGAL OWNER OF.AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL - O O 1. 0,0 0
PROPERTY.
4-80
SIGNATURE 010. ,
OF PERMITTEE
TRO P CESSED BY
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INDUSTRIAL
WASTE APPROVAL