HomeMy Public PortalAbout10909 FREER ST_Plumbing__ TGAGGTC[ (CK-81715) -t/T■
APPLICATION FOR PLUMBING PERMIT
BUILDI AND SAFETY DIV N
FOR APPLICANT TO FILL. IN (PRINT OR TY PEI BUILDING , /�
NUMBER FIXTURE OR ITEM O FEE ADORESSf�C2
WATER CLOSET
LOCALITY
BATH TUB NEAREST
CROSS ST.
SHOWER OWNER
LAVATORY LtAIL
ADDRESS
SINK CITY TEL. NO.
DISHWASHER CONTRACT
CLOTHES WASHER
ADDRESS
SWIMMING POOL RECEPTOR _
CITY L NO.
LAWN SPRINKLER SYSTEM
STATE C!C
WATER HEATER LICENSE NO. CLASS
GAS S UT ETS DLSTRICT N0. UP NE ESS BY
CC
U TS VER p�y�Rl .LG IC
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6 P R 3 -- WASTE APAPROVAL 11001 a
INSPECTION RECORD
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Plan check fee
PLUMBING PERMIT ISSUING FEE 8
TOTAL FEE
Plan check applicant
Name APPROVALS. DATE INSP[CTOR'G SIGMATURK
UNDER SLAB WORK
Address ROUGH PLUMBING 7�
City Tel. No. GAS PIPING
I HERESY ACKNOWLEDGE THAT I HAYE READ THIS Ab PLICATION GAS VEN-t
AND
STATE THAT THE A[ CORR[f AND AGR[[ TO COMELY
WITH ALL COUNTY 0 AMC AND T[ LAWS RESULATrXG HOT WATER HEATER
FLUMSrNG.
I HERESY CERT THA I AM FR LY REGISTERED AMD/OR PLUMBING FIXTURES
LICENSED AS R[ RED LOS AMG [ COUNTY AND STAT[ OF GAS TEST
CALIFOR,MIA OR T I THE L[G MEN OK, AND INTEND TO
R[GIDE IR THE v G SED R I TIAL P ERTY. UTILITY CO. NOTIFIED
81 ONATU 42
OF PE E FINAL
PLAN C ECK VALIDATION GK. M.6. CASH PERMIT VALIDATION CK. m.o. CASH
5s2 �Ci 1) 13.50
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