HomeMy Public PortalAbout6047 GOLDEN WEST AVE_Plumbing__ 78A667C (CE-81713) -9/75 - -
)_ { "^r : APPLICATION FO PLUMBING PERMIT
- 110
� 7
BUILDING AND SAFETY DIVI ON A/
FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING
NUMB FIXTURE OR ITEM @ FEE ADDRESS
� WATER CLOSET LOCALIT
BATH TUB 300 CROSS ST
SHOWER OWNER
MAIL
AIL
LAVATORY U U MAIL
DDRESU—
SINK 31od CITY TEL NO
DISHWASHER CONTRACTO
CLOTHES WASHER jf
ADDRESS
SWIMMING POOL RECEPTOR
CITY �� TEL NO
LAWN SPRINKLER SYSTEM ,-,
0 STATE LIC C ��ib Y-
WATER HEATER LICENSE N CLASS
CL.
DISTRICT NO. GROUP E ESSED BY C
GAS SYSTEM OUTLETSO C.')
6
_
OUTLETS OVER
5 PER SYSTEM INDUSTRIAL
WASTE APPROVAL yVj
INSPECTION RECORD h
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"T/3
Plan check fee
PLUMBING PERMIT ISSUING FEE $
TOTAL FEE
Plan check applicant
Name APPROVALS DATE INSPECTOR S 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 ,l
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST -2-0w OVIJ b
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND T
RESIDE IN THE ABOVE DESCRIBED RESIjQjT1AL PROPERTY UTILITY CO NOTIFIED
SIGNATU RE
OF PERMITTEE INAL - -'
PLAN CHECK VALIDATION CK M o CASH PERMIT VALIDATION CK M ASH
91.9..r•SEP 1 2 5.5 0 A