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HomeMy Public PortalAbout5429 GOLDEN WEST AVE_Plumbing__ i 76A667A CE 1117(REV.6/781 ©5 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Golden hold NUMBER FIXTURE OR ITEM @ FEE 29 °1.°l,�T?{ , WATER CLOSET LOCALITY NEAREST BATHTUB CROSS ST. SHOWER OWNER LAVATORY MAIL ADDRESS SINK CITY TEL.NO. DISHWASHER CONTRACTOR CLOTHES WASHER ADDRESS SWIMMING POOL RECEPTOR -"--" .._----_-- CITY7 TEL.NO LAWN SPRINKLER SYSTEM STATE LIC. WATER HEATER LICENSE NO. ' i' CLASS GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR'S SIGNATURE OUTLETS OVER UNDER SLAB WORK >- 5 PER SYSTEM ROUGH PLUMBING O GAS PIPING V W GAS VENT L HOT WATER HEATER �. DG PLUMBING FIXTURES GAS TEST C Plan check fee UTILITY CO.NOTIFIED PLUMBING PERMIT ISSUING FEE$ Lu F- TOTAL FEE FINAL PLAN CHECK VALIDATION Plan check applicant ' 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 OF PERMITTEE DISTRICT NO PROCESSED BY INDUSTRIAL WASTE APPROVAL