HomeMy Public PortalAbout6045 GOLDEN WEST AVE_Plumbing__ 76A667C 1—%8178) -9/75
APPLICATION FOR PLUMBING PERMIT
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN (PRINT OR TYPEI BUILDING f
NUMB FIXTURE OR ITEM @ FEE ADDRESS
LOCALITY 7�
WATER CLOSET
NEAREST
BATH TUB Q CROSS ST
SHOWER 6� OWNER
LAVATORY MAIL
ADDRESS
SINK Q 6 CITY TEL NO
DISHWASHER O O CONTRACTOR
CLOTHES WASHER
ADDRESS O
SWIMMING POOL RECEPTOR
CITY TEL NO
� LAWN SPRINKLER SYSTEM
STATELT ,6
WATER HEATER U LICENSE NO --7/ CLASS o
DISTRICT NO. GROUP ONE CESS ED BY v
GAS SYSTEM OUTLETS b(�
OUTLETS OVER _5 � ��'
5 PER SYSTEM INDUSTRIAL w
WASTE APPROVAL N
INSPECTION RECORD
Plan check fee
PLUMBING PERMIT ISSUING FEE $
TOTAL FEE
Plan check applicant
Name APPROVALS DATE INSPECTORS SIGNATURE
UNDER SLAB WORK
Address
ROUGH PLUMBING
City Tel NO GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT .
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT I AM THE EGAL OWNER OF ND INTEND TO
RESIDE IN THE ABOVE DES 8 !DENT IAL P P R7� UTILITY CO NOTIFIED 1p,
SIGNATURE W /
OF PERMITTE FINAL
PLAN CHECK VALIDATION CK M.O CASH PERMIT VALIDATION CK M.O. CASH
sEP 13 5 .0 5
() 49-3