HomeMy Public PortalAbout6047 1/2-6047 3/4 GOLDEN WEST AVE_Plumbing__ 76A667C (CE-8178) -8/73 '✓� �" < '
APPLICATION FOR PLUMBING PERMIT
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING /7 1 A
NUMBER FIXTURE OR ITEM @ FEE ADDRESS - �-+7' a7 �) n✓
WATER CLOSET e--v LOCALITY
NEAREST
BATH TUB a-V CROSS ST
SHOWER OWNER
LAVATORY MAIL` ADDRESS
SINK U-L) CI7� � TEL NO
Z DISHWASHER O-V CONTRACTO
'Z CLOTHES WASHER
d-V ADDRESS - � CY
'—' SWIMMING POOL RECEPTOR
CITY TEL NOS
LAWN SPRINKLER SYSTEM
STATE LIC
2 WATER HEATER LICENSE NOCLASS
a
DISTRICT NO. GROUPZONE RO SED BY O
GAS SYSTEM SZUTLETS I
_ OUTLETS OVER-31 CJ IffG_
5 PER SYSTEM
3,5 INDUSTRIAL V
WASTE APPROVAL LJ
a
INSPECTION RECORD v7
Plan check fee
PLUMBING PERMIT ISSUING FEE $ J�
TOTAL FEE
Plan check applicant
Name APPROVALS DATE INS,GE,CTOR'S SIGNATURE
UNDER SLAB WORK
Address -- ROUGH PLUMBING ,� r
City Tel No GAS PIPING 05
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AG TO COMPLY
WITH ALL COUNTY •ORDINANCES AND STATE L 5 REG ATING HOT WATER HEATER
PLUMBING. '
I HEREBY CERTIFY THAT I AM P OPERLY GIS E D A / R PLUMBING FIXTURES
LICENSED AS REOUI RED BY LOS GE ES CO NTY T E F GAS TEST
CALIFORNIA OR THAT I AM THE G OWN OF, A D NT NO TO
RESIDE IN THE ABOVE DESCRIB E DENTIAA- PR ER UTILITY CO NOTIFIED
r
SIGNATURE - ,�
OF PERMITTEE FINAL
PLAN CHECK VALIDATION CK M O CASH PERMIT VALIDA 10 , cK M.0 CASH
.6 2.8.5 A98
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