HomeMy Public PortalAbout5012 FIESTA AVE_Plumbing__ 76 A 667 A(C E8r17 A) 8/75 t
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APPLICATION ORP MBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING �.�� y
MAKE CHECKS PAYABLE TO ADDRESS
HARVEY T BRANDT, COUNTY ENGINEER LOCALITY
FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST
NUMBER FIXTURE OR ITEM @ FEE CROSS ST
WATER CLOSET OWNER—�
MAIL
BATH TUB ADDRESS
SHOWER 0 v CITY TEL NO
LAVATORYCONTRACTOR
---
SINK ADDRESS J101
Y
DISHWASHER CITY TEL NO
CLOTHES WASHER ?j STATE y LIC
SWIMMING POOL RECEPTOR LICENSE NO 1 CLASS
DISTRICT NO GROUPNE �'�(ROCESSED BY
LAWN SPRINKLER SYSTEM �V �+ ,i ( J
WATER HEATER 3 INDUSTRIAL ��JJ
WASTE APPROVAL
GAS SYSTEM OUTLETS INSPECTION RECORD O
OUTLETS OVER
5 PER SYSTEM V26 TP, C*401�'�— fC U
OC
O
F
U
W
4.
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Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEE $
TOTAL FEE
APPRbVALS DATE INSPECTOR 4 SIGNATURE
Plan check applicant UNDER SLP WORK 7-:26 76
Name 47--y-110
ROUGH PLUMBING `4b'9d�.,� ,��
Address �0 f++ GAS PIPING
City Z Tel NO {� ft GAS VENT
o OBD HOT WATER HEATER
I HEREBY ACKNOWLEDGE HAT I 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
PLUMBING GAS TEST
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED
LICENSED AS 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 PROPERTY FINAL
SIGNATURE
OF PERMITTEE
PERMIT VALIDATION cK M o CASH
PLAN CHECK VALIDATION CK O "l,-3 3 2 5 -0 3 4.� � ���