HomeMy Public PortalAbout5709 GOLDEN WEST AVE_Plumbing__ I, 76A667 (CE-817)-B-71 ��✓ / /f� f✓/ _��Ty�
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APPLICATION FOR PLUMBING ,PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
., ADDRESS
I' LOCALITY -��
FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST
CROSS ST. Illi
NUMBER FIXTURE OR ITEM @ FEE
OWNER ��L
WATER CLOSET 1 75 '•
BATH TUB 1 75 MAILS'7(-,P rd4 n�� SfT�,
ADDRESS /v
SHOWER 1 75 CITY �OG� • TEL NO. -y•
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LAVATORY 1 75 CONTRACTOR
SINK 1 75 ADDRESS
DISHWASHER 1 75 CITY' EL NO -
r
CLOTHES WASHER 1 75 STATE LIC 5 +'A
LICENSE NO CLASS
-SWIMMING"POOI.RECEPTOR''-1'75"
DISTRICT NQ GRID ZONE R§&E BY
LAWN SPRINKLER SYSTEM 1 75
WATER HEATER 1 757, INDUSTRIAL .1
WASTE APPROVAL 0
GAS SYSTEM OUTLETS 1 75 NSPE ON RE D V
OUTLETS OVER
5 PER SYSTEM .30 �� -1�_�C•, 0
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Plan check fee See reverse.
PLUMBING PERMIT ISSUING FEE $ 3 00
TOTAL FEE
APPROVALS DATE INSPECTOR'S SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING J
City Tel NO GAS VENT- 1
HOT WATER HEATER
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING GAS TEST
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND ST TE OF
CALIFORNIA E THAT EAM
S THE LE L OWER fjF, AND I T NO TO
RESIDE IN THE ABOVE DESCRfBED SIDENNE LRROPERT7r FINAL V141 ?
SIGNATURE f\
OF PERMITTEE ,
PERMIT VALIDATION CK M O CASH
PLAN CHECK VALIDATION CK M O CASH
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