HomeMy Public PortalAbout5956 GOLDEN WEST AVE_Plumbing__ •i 76A66 (C.L--_17)-8-71
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
t.
LOCALITY
FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST
NUMBER FIXTURE OR ITEM @ FEE CROSS ST
OWNER
WATER CLOSET 1 75
MAIL
BATH TUB 1 75 ADDRESS
SHOWER 1 75 CITY TEL. NO
LAVATORY 175 CONTRACTOR
SINK 1 75 ADDRESS
DISHWASHER 1 75 CITY L.-NO
CLOTHES WASHER 1 75 STATE LIC
C
SWIMMING POOL RECEPTOR 1 75 LICENSE NO , LA
DISTRICT 0 GROUP Z¢JAE PROJCES
LAWN SPRINKLER SYSTEM 1 75 y 41f
WATER HEATER 1 75 INDUSTRIAL IC6
WASTE APPROVAL
GAS SYSTEM OUTLETS 1 75 7� INSPECTION RECORD u
OUTLETS OVER ,30 Z_
5 PER SYSTEM
Lu
V1
z
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
City
Tel NO GAS VENT
HOT WATER HEATER
I HEREBY ACKNOWLEDGE THAT 1 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 GAS TEST
PLUMBING I
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF.{{j AND INTEND TO
RESIDE IN THE AB DF.$CR RESID NTIA ��� TY w FINAL
SIGNATURE
OF PERMITTEE+,,.,_,,,, PERMIT VALIDATCK� M O CASH
PLAN CHECK VALIDATION CK M.O CASH
-3 7 AUG 5 D 4.7 5N