HomeMy Public PortalAbout6049 GOLDEN WEST AVE_Plumbing__ 76A667C (CE-8178) -9/75
APPLICATION FOR PLUMBING PERMIT
BUILDING AND SAFETY DIVISION ppp
FOR APPLICANT TO 77777"(PRINT OR TYPE) BUILDING
NUMBER FIXTURE OR ITEM @ FEE ADDRESS
WATER CLOSET ( LOCALI
NEAREST
BATH TUB
(}� CROSS ST 7
SHOWER OWNER C-9-- pXA
t LAVATORY MAIL
ADDRESS
SINK
C ITY—'K:* �� TE NO
DISHWASHER
CONTRACTOR"Q , a
CLOTHES WASHER
ADDRESS
SWIMMING POOL RECEPTOR
CITY TEL NO(
LAWN SPRINKLER SYSTEM ('Z240
.��
STATE n �y p LIC
WATER HEATER y C LICENSE NO t��t_U<- CLASS .. CL.
O
DISTRICT NO. GROUP OCE D BY v
GAS SYSTEM OUTLETS
OUTLETS OVER O 8 o
5 PER SYSTEM INDUSTRIAL w
WASTE APPROVAL N
INSPECTION RECORD z
Plan check fee
PLUMBING PERMIT ISSUING FEE $ (� '-0
TOTAL FEE
Plan check applicant
Name APPROVALS DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK g:7-S?-76 r�
Address
ROUGH PLUMBING ".
City Tel No GAS PIPING /
i HEREBY ACKNOWLEDGE THAT I HAVE READ IS APPLICATION GAS VENT
y
AND STATE THAT THE ABOVE IS CORRECT A .D AG EE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LA S EGULATING HOT WATER HEATER
PLUMBING
I HEREBY CERTIFY THAT I OPE LY RE ESTE ED AN OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY L GEL S COUN Y A STA OF GAS TEST v d'
CALIFORNIA OR THAT I AM T E GAL WNER D INTE TO '
RESIDE IN THE ABOVE DESCR ESID TIA OP TY UTILITY CO NOTIFIED
SIGNATURE
OF PERMITTEE FINAL ^s
PLAN CHECK VALIDATION CK M.0 CASH PERMIT VALIDAT 0 cK M.0' CASH
2'41it"' fP.-2p 5 'a 2 C� s
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