HomeMy Public PortalAbout5414 GOLDEN WEST AVE_Plumbing__ CE 1;('REV,
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CE 1RE V.6/78)
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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
ADDRESS 14 GO .dd® tT
NUMBER FIXTURE OR ITEM @ FEE est
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LOCALITY i.e. 4-7 .EY
WATER CLOSET
NEAREST
BATH TUB CROSS ST.
SHOWER OWNER ;.j _
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LAVATORY MAIL
ADDRESS
SINK CITY TEL.NO.
DISHWASHER CONTRACTOR
CLOTHES WASHER ADDRESS
SWIMMING POOL RECEPTOR — ---"----"`
CITY _ TEL.NO.0
LAWN SPRINKLER SYSTEM STATE LIC.
WATER HEATER LICENSE NO. i 1' c ! CLA55B C 36
GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR'S SIGNATURE
OUTLETS OVER UNDER SLAB WORK a.
5 PER SYSTEM ROUGH PLUMBING O
GAS PIPING U
W
GAS VENT
HOT WATER HEATER >-
aC
PLUMBING FIXTURES 9
GAS TEST O
Plan check feea
UTILITY CO.NOTIFIED
PLUMBING PERMIT ISSUING FEE$
TOTAL FEE FINAL
&L/10-
Plan check applicant
PLAN CHECK VALIDA lON
Name
Address
City Tel.No.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING. PERMIT VALIDATION
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 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.
SIGNATURE rs
OF PERMITTEE
DISTRICT NO. PROCESSED BY
INDUSTRIAL
WASTE APPROVAL