HomeMy Public PortalAbout10056 GREEN ST_Plumbing__ 7GA667C (CE-81713) -9/75
' APPLICATION FOR PLUMBING PERMIT
BUILDING AND SAFETY DIVISION T b
FOR APPLICANT TO FILL IN (PRINT OR TY PEI BUILDINGADDRESS / Q�J/� '� �'/��� /E!
NUMBER FIXTURE OR ITEM @ FEE
WATER CLOSET LOCALITY
NEAREST J
BATH TUB CROSS ST.
SHOWER OWNERMAIL
LAVATORY ADDRESS /OL)j
SINK CITY r�17 TEL. NO.5y
DISHWASHER CONTRACTOR
C) v
CLOTHES WASHER
ADDRESS, Z
SWIMMING POOL RECEPTOR
CITY /VC
TE L. NNLAWN SPRINKLER SYSTEM �
STATE (� �Q LIC
WATER HEATER LICENSE NQ--1 CLASS��
DISTRICT NO. GROUP ZONE PROCESSED BY O
GAS SYSTEM OUTLETS C? ,1, ,�.f C
OUTLETS OVER V
O
5 PER SYSTEMU
INDUSTRIAL
WASTE APPROVAL yI
101-
INSPECTION
INSPECTION RECORD Z
Plan check fee
PLUMBING PERMIT ISSUING FEE S f
TOTAL FEE jt
Plan check applicant
Name / APPROVALS DATE INSPECTOR'S SIGNATURE
//�� P�A UNDER SLAB WORK
Address/ / CS rc ROUGH PLUMBING
City g� I Tel. No �� GAS PIPING
LOEBY ACKNOWLEDGE THA I VE READ THIS APPLICATION GAS VENT
TE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
LL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
G.
EBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES ;I
AS REOUI RED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
IA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TOS
N THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO. NOTIFIEDUREERMITTE
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION - 1 M.0. CASH
95O7.5UA
76A667-CE617-11-57
APPLICATION FOR PLUMBING PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ABUILDING DDRESS G`�G'tiJ
JOHN A. LAMBIE, Count y Engineer
CASSATT D. GRIFFIN. Supt of Building /
LOCALITY
FOR APPLICANT TO FILL IN CNEAREST
ROSS ST. e
NUMBER FIXTURE OR ITEM 3
/ WATER CLOSET OWNERe 0 e��
MAIL
BATH TUB ADDRESS
SHOWER CITY TEL. NO.
LAVATORY CONTRACTOR '
SINK ADDRESS115g-Z4 r j e �1e,
DISHWASHER CITY d fG TEL. NO.
CONT CTO S STAT
LAUNDRY TUB
REGISTRATION NO. COUNTY ❑
CLOTHES WASHER DI STRI T O. GRPAJ56 ZONE READY FOR INSPECTION
WATER HEATER j
GAS SYSTEM / INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
p APPROVALS
PER ITEM _ ._ DATE INSPECTOR'S SIGNATURE
` fT71 OR FDCTUBE $ o
UNDER SLAB WORK _ -
PERMIT $ 00 ROUGH PLUMBING Z�/
TOTAL FEE GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 HAVE A IS PLICATION GAS VENT
AND STATE THAT THE ABOVE IS AGREE 0 COMPLY HOT WATER HEATER
WITH ALL COUNTY ORDINA AN S E LAWS GULATING
PLUMBING. PLUMBING FIXTURES
I HEREBY CERTIFY A I LY REGIS RED AND/OR GAS TEST ,�,,� `en
LICENSED AS REQU B LOS ES UNT AND STATE OF -
CALIFORNIA OR M OF THE ABOVE UTILITY CO.NOTIFIED
DESCRIBED RESIT N AL
SIGNATURE
OF PERM-UT FINAL _
ROBERTA.WOOD.
OF LIDATION SUPERVISING MECHANICAL ENG'R
(!.:.:7 Y.O. CASH
./ 6 2 3 7 ° OCT 3 0 5 A 13-00 �.�;: