HomeMy Public PortalAbout4911 HALLOWELL AVE_Plumbing__ /p f
7GA66,71 10Er.`.17E) -4177 r
APPLICATION FOR PLUMBING PERMIT
ti BUILDING AND SAFETY DIVISION
FOR APPLICANT TO,FILL IN(PRINT OR TYPE) BUILDING _
I
NUMBER FIXTURE OR-ITEM FEE ADDRESS l
WATER CLOSET LOCALITY
NEAREST H
BATH TUB CROSS ST 2 - /4
SHOWER OWNER`MAIL
LAVATORY ADDRESS 4V '
SINK ('rU CITY4L�(� TEL.NO �C,t7
DISHWASHER CONTRACTOR
CLOTHES WASHERel
ADDRESS
SWIMMING POOL_RECEPTOR
_ CITY TEL NO
LAWN SPRINKLER SYSTEM
STATE LIC
WATER HEATER., LICENSE NO CLASS
GAS SYSTEM OUTLETS DISTRICT NO GR
QU ZONE RO SED BY
OUTLETS OVER �•'✓ �—/L, / ` CD
S PER SYSTEM INDUSTRIAL
WASTE APPROVAL III
INSPECTION RECORD Ct
U
Y ) W
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_
Plan check fee '
-PLUMBING PERMIT-ISSUING FEE$
TOTALFEE ` 0
Plan check applicant
APPROVALS DATE N CTOWS SIGNATURE
Name
UNDER SLAB WORK A-2-1-79
Address ROUGH PLUMBING
City Tel No GAS PIPING /
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT "
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING HOT WATER HEATER
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE GAS TEST
LEGAL OWNER OF.AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL
PROPERTY Y UTILITY CO.NOTIFIED
SIGNATURE
OF PERMITTEE FINAL
PLAN CHECK VALIDATION CK M.O CASH PERMIT VALIDATION M.o CASH
' _ 0.6'2�Jtiid• 2D ,5 D 1 �.Q 0 ���