HomeMy Public PortalAbout5728 GOLDEN WEST AVE_Plumbing__ 76A661rA.'
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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING �J�
NUMBER FIXTURE OR ITEM ® FEE ADDRESS G
WATER CLOSET
s LOCALITY W,� �J
NEAREST d-- ,t I-'
BATHTUB CROSS ST
SHOWER MAIL
OWNER !lj
LAVATORY ADDRESS 5 f'
SINK CITY 'n - 3 T TEL NO
DISHWASHER CONTRACTOR
CLOTHES WASHER ADDRESS
Q•
SWIMMING POOL RECEPTOR
CITY` / TEL NO 35'�
LAWN SPRINKLER SYSTEM ATE )
LIC
WATER HEATER S CENSE NO O'er vc";)4,1 CLASS
/ GAS SYSTEM OUTLETS .� APPROVALS DATE NECTOR'S SIGNATURE
OUTLETS OVER UNDER SLAB WORK dG
5 PER SYSTEM ROUGH PLUMBING D
GAS PIPING
GAS VENT
@3
HOT WATER HEATER
PLUMBING FIXTURES
GAS TEST � ��
Plan Check fee UTILITYCO NOTIFIED
PLUMBING PERMIT ISSUING FEE$ Z
FINAL
TOTAL FEE
p B/I f/ ✓ �i� ,'r
Plan check applicant PLAN CHECK VALIDATION
Name
Address
G
City Tel No
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE - 3�7 (� n
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES // i/� 9 A
AND STATE LAWS REGULATING PLUMBING PERMIT VALIDATION I
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED A D/OR LICENSED AS
REQUIRED BY LOSANGELES COUY AND STATE OF CALIFORN R THAT I AM THE 9,00
T
LEGAL OWNER�OF AND TEND O ESID THE ABOVE DES RIB RESIDENTIAL 2 Q Q 1 9t 0 0 I '
PROPERTY
001900
SIGNATURE
OF PERMITTEE '
04. 1 3-79
DIS ICT O PROCESSED BY
sTo
IND LISTRI
WASTE APPROVAL
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