HomeMy Public PortalAbout5448 ENCINITA AVE_Plumbing__ 76A667A!CE 8178) 11176
APPLICATION FOR PLUMBING-PERMIT �s
Y
BUI G AND SAFETY DIVISIO�
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING 6—i
NUMBER FIXTURE OR ITEM @ FEE ADDRESS
WATER CLOSET LOCALITY
NEAREST
BATH TUB CROSS ST
SHOWER OWNER
LAVATORY MAIL ADDRESS
45
ADDRESS
SINK CITY TEL NO
DISHWASHER CONTRACTOR
CLOTHES WASHER
ADDRESS
SWIMMING POOL RECEPTOR
CITY TEL NO yl77
LAWN SPRINKLER SYSTEM STATE �f /
WATER HEATER
LICENSE NO "�'��7 L- CLASS
GAS SYSTEM OUTLETS DISTRICT NO SUP NE PR ESSED
OUTLETS OVER _/ A_
5 PER SYSTEM INDUSTRIAL 0.
WASTE APPROVAL
INSPECTION RECORD u
O
®.
will,
z
Plan check fee
PLUMBING PERMIT ISSUING FEE$
TOTAL FEE
Plan check applicant
APPROVALS DATE INSPECTOR S SIGNATURE
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
1 HEREBY CERTIFY THAT I AM_PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES_ y�
REQUIRED BY LOS ANGELES COUNTY AND ST E OF CALIFORNIA OR THAT I AM THE-_ '7 TEST O .9 1'7
LEGAL OWNER OF AND INTEND TEY ESIDE HE ABOVE DESCRIBED RESIDENTIAL +
PROPERTY UTILITY CO NOTIFIED
SIGNATURE ,
OF PERMITTEE FINAL
t' >
PLAN CHECK VALIDATI N CK M o CASH PERMIT'VALIDATION cK ;, M o CASH +
`r
e C JUL ii 5 7.5 G
0�S