HomeMy Public PortalAbout6322 GOLDEN WEST AVE_Plumbing__ 79AG57C (CIE-8170) -9/75
APPLICATION FOR PLUMBING PERMIT
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN (MINT OR TYPE) BUILDING
NUMBER FIXTURE OR ITEM O FEE ADDRESS
WATER CLOSET LOCALITY
NEAREST
BATH TUB CROSS ST.
SHOWER OWNER
LAVATORY MAIL
ADDRESS
SINK CITY TEL.
DISHWASHER CONTRAC
CLOTHES WASHER
ADDRE r
SWIMMING POOL RECEPTOR
LAWN SPRINKLER SY M
TATE LIC
WATER LICEN NO. 17 CLASS o
DISTRICT GROUP ZpNE P ESS BY v
GAS SYST OUTLETS �� Q A - K7 ` p�
UTLET OVER p�STRIq� Cl �`'! 0
6 PER SYSTEM Iy& AMOVAL
INSPECTION RECORD ?
Plan check fee
PLUMBING PERMIT ISSUING FEE 8
TOTAL FEE
Plan check applicant
NameAPPROVALS DATE INSPECTOR'S OIONATUR[
UNDER SLAB WORK
Address ROUGH PLUMBING
CitLIN
Tel. No. GAS PIPING
EBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
T[ THAT THE ABOVE ID CORRECT AND AGREE TO COMPLY
LL COUNTY OADINAPIC ES AND !TATE LAWS REGULATING HOT WATER HEATER
G.
EBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
D AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
NIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO
N TH!ADOV! D[SCRIS[D R611D[N PROPER UTILITY CO. NOTIFIED
U RE 42ERMITTIE FINAL
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
0 4 81--AN 5 5 B 7-5 0 ,&b-,,,