HomeMy Public PortalAbout5420 GOLDEN WEST AVE_Plumbing__ 76A667A
CE 817(REV.6/781
P'S
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING e'�yy rw
NUMBER FIXTURE OR ITEM @ FEE ADDRESS 5420 Golden gest
WATER CLOSET LOCALITY �r
NEAREST
BATH TUB CROSS ST. �y
SHOWER OWNER i o-' 'haven !",ev. COT
AVATORY MAIL
ADDRESS
SINK CITY TEL.NO.
DISHWASHER CONTRACTOR y ^
CLOTHES WASHER ADDRESS
SWIMMING POOL RECEPTOR — -----
CITY TEL NO- -r-,�^.
LAWN SPRINKLER SYSTEM STATE i LIC.
WATER HEATER LICENSE NO. jj CLASS
GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR'S SIGNATURE
OUTLETS OVER UNDER SLAB WORK
5 PER SYSTEM ROUGH PLUMBING O
GAS PIPING U
W
GAS VENT
HOT WATER HEATER y.
®L
PLUMBING FIXTURES 9
GAS TEST 0
Plan check fee UTILITY CO.NOTIFIED
PLUMBING PERMIT ISSUING FEE$
TOTAL FEE FINAL J
Plan check applicant
PLAN CHECK VALIDATION 4Z
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 IHEREBY 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