HomeMy Public PortalAbout4941 GOLDEN WEST AVE_Plumbing__ 7Gwu7C (Ct-[t71111) -+/7[ .
APPLICATION FOR PLUMBIr -PERMIT
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN (PRINT OR TY PEI BUILDING
NUMBER FIXTURE OR ITEM 0 FEE ADDRESS
WATER CLOSET D LOCALITY
NEAREST
BATH TUB CROSS ST.
SHOWER OWNER
13 60
LAVATORY MAIL
ADDRESS
SINK CITY TEL.NO.
DISHWASHER CONTRACTOR
CLOTHES WASHER
ADDRESS
SWIMMING POOL RECEPTOR
C 1 TY TE L. N
LAWN SPRINKLER SYSTEM
STA LIC
WATER HEATER LICENSE NO CLASS
GAS SYSTEM OUTLETS
DISTRICT Ni GROUP N PR SSED BY
� I � S
OUTLETS OVER
6 PERSYSTEM
W D STR�ALOVAL
7E A PA INSPECTION RECORD y�
T Z_
Plan check fee /
PLUMBING PERMIT ISSUING FEE $
TOTAL FEE
Plan check applicant
Name APPROVALS DATE INSPECTOR'S SIONATUR[
UNDER SLAB WORK
Address ROUGH PLUMBING
City Tel. No. GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WLTH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
I HEREBY CERTIFY THAT I AM PROPERLY RE'GIGTERED AMD/OR PLUMBING FIXTURES
LI CEN-0ED AS REQUIRED BY LOG ANGELES COUNTY AND STAT[ OF GAS TEST
CALIFORNIA OR THAT I THE LEGAL OWN R OF, INTEND TO
RESIDE IN THE ABOVE D[ ISED RE.IDINTI FRO UTILITY CO. NOTIFIED
SIGNATURE
OF PERMITTEE FINAL
PLAN CHECK AL AVON CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
671 15 5 D 22-5QA0-13