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HomeMy Public PortalAbout5400 GOLDEN WEST AVE_Plumbing__ 76A667A .��}��-qq// CE 817 IRE V.6/781 3- ©s APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING f ' NUMBER FIXTURE OR ITEM Q FEE ADDRESS �q WmLqt LOCALITY r°ae1M`0 6 e ; WATER CLOSET NEAREST BATH TUB CROSS ST. h� ��s SHOWER OWNER ex. , ven Sieve co • LAVATORY MAILADDRESS SINK CITY TEL.NO. DISHWASHER CONTRACTOR','Jorsey Plumbing CLOTHES WASHER ADDRESS C.zaw��k/i/ i':'9l{)t`3e,".'$s SWIMMING POOL RECEPTOR �i$� 4� g� CITY t 9 Verne me TEL.NO. LAWN SPRINKLER SYSTEM STATEr7i� LIC. WATER HEATER LICENSE NO 31CLASS GAS SYSTEM OUTLETS APPROVALS DATE INSPECTORS SIGNATURE OUTLETS OVER UNDER SLAB WORK >- 5 PER SYSTEM ROUGH PLUMBING 0 GAS PIPING U W GAS VENT HOT WATER HEATER >- PLUMBING FIXTURES Q GAS TEST 0 Plan check feea UTILITY CO.NOTIFIED PLUMBING PERMIT ISSUING FEE$ WH TOTAL FEE FINAL Plan check applicant PLAN CHECK VALIDATION Name Address City Tel. No. , i, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE .THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES 'f" p • yy i; AND STATE LAWS REGULATING PLUMBING. PERMIT VALIDATION IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REOU IR ED 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. "F • SIGNATURE .... ' OF PERM ITTEE DISTRICT NO PROCESSED BY INDUSTRIAL WASTE APPROVAL