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HomeMy Public PortalAbout5435 GOLDEN WEST AVE_Plumbing__ 76e@664A CE 817(REV.6/78) ©5 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ADDRESS r t.,' �,. NUMBER FIXTURE OR ITEM � FEE WATER CLOSET LOCALITY +� NEAREST BATH TUB CROSS ST. SHOWER OWNER cr cam- .,f 'r�'7 pay, corp. LAVATORY MAIL ADDRESS SINK CITY TEL.NO. DISHWASHER CONTRACTOR CLOTHES WASHER ADDRESS SWIMMING POOL RECEPTOR CITY • f� TEL.NO.59C�, yJ ' �y LAWN SPRINKLER SYSTEM STATE LIC. WATER HEATER LICENSE NO. 31 r.421 CLASS GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR'S SIGNATURE OUTLETS OVER UNDER SLAB WORK d 5 PER SYSTEM ROUGH PLUMBING O GAS PIPING Lu W GAS VENT LL HOT WATER HEATER >. PLUMBING FIXTURES Q GAS TEST O Plan check feed UTILITY CO.NOTIFIED PLUMBING PERMIT ISSUING FEE$ TOTAL FEE FINAL Plan check applicant PLAN CHECK VALI A 'I 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 - >r 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 tl k. ! Y OF PERM ITTEE DISTRICT NO. PROCESSED BY i INDUSTRIAL ` WASTE APPROVAL h