HomeMy Public PortalAbout5426 GOLDEN WEST AVE_Plumbing__ I
76A667A
CE 817(REV.6/78)
P�S
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
ADDRESS " !
ept
NUMBER FIXTURE OR ITEM ® FEE
OCALITY
WATER CLOSET L1
NEAREST
BATHTUB CROSS ST,
SHOWER OWNER F"' ; r, r. /�
.c 1 s n :V, v• Corn.
e
LAVATORY MAIL
ADDRESS
SINK CITY TEL.NO.
DISHWASHER CONTRACTOR DorseyFlumbing Co.
CLOTHES WASHER
ADDRESS 800 118 i.C3me res
SWIMMING POOL RECEPTOR �n �{'� ��
CITY •e.-� a `ne .�7�_TEL.NO. —088
LAWN SPRINKLER SYSTEM STATE ^yam LIC.
.a�
WATER HEATER LICENSE NO. t 542 1 CLASS ? 36
GAS SYSTEM OUTLETS APPROVALS DATE INSPECTORS SIGNATURE
OUTLETS OVER UNDER SLAB WORK
5 PER SYSTEM ROUGH PLUMBING O
GAS PIPING 6J
as7
J
GAS VENT
HOT WATER HEATER }
OC
PLUMBING FIXTURES
GAS TEST O
Plan check fee UTILITY CO.NOTIFIED d
PLUMBING PERMIT ISSUING FEE$
TOTAL FEE FINAL
Plan check applicant PLAN CHECK VALIDA ON
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
aµ z WE }
1 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. -
Y �r,
SIGNATURE
OF PERMITTEE
DISTRICT NO PROCESSED BY
INDUSTRIAL
WASTE APPROVAL