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HomeMy Public PortalAbout5417 GOLDEN WEST AVE_Plumbing__ CC1 E 817 7& E 81WEV.6/78) ©S APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING NUMBER FIXTURE OR ITEM @ FEE ADDRESS 542.7 Golden Vest WATER CLOSET LOCALITY T1 m ?S . NEAREST BATHTUB CROSS ST. SHOWER OWNER 3 ""haven Dev. LAVATORY MAIL ADDRESS SINK CITY TEL.NO. DISH WASHER CONTRACTOR CLOTHES WASHER ADDRESS SWIMMING POOL RECEPTOR CITY TEL.NOS; LAWN SPRINKLER SYSTEM STATE LIC. WATER HEATER LICENSE NO. CLASS (` GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR'S SIGNATURE OUTLETS OVER UNDER SLAB WORK 5 PER SYSTEM ROUGH PLUMBING O GAS PIPING u LLJ GAS VENT J U. HOT WATER HEATER } OC PLUMBING FIXTURES GAS TEST O Plan check fee UTILITY CO.NOTIFIED 4 PLUMBING PERMIT ISSUING FEE$ TOTAL FEE FINAL Plan check applicant PLAN CHECK VALID TIO Name Address City Tel. No. I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES °• Y'ti r-p. ; 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 ` OF PERM ITTEE DISTRICT NO. PROCESSED BY INDUSTRIAL WASTE APPROVAL