HomeMy Public PortalAbout5240 HALLOWELL AVE_Plumbing__ epee C (CE_e,7B) .9/KEA Y FOR FINAL ,I SPE I0N-
APPLICATION FOR PLUMBING PERMIT
BUILD( G AND SAFET D ISION
FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING
NUMBER FIXTURE OR ITEM @ FEE ADDRESS
.401
LOCALITY
WATER CLOSET .
NEAREST
BATH TUB CROSS ST. gi J, '
SHOWER OWNER
LAVATORY MAIL '
ADDRESS
SINK CITY TEL. NO.
DISHWASHER CONTRACTORPACIFIC INSTALL7
CLOTHES WASHER
ADDRESS 10920R A^,'; /^
SWIMMING POOL RECEPTOR
CITY MARI L.CNA _
STATE ` _ 8
LAWN SPRINKLER SYSTEMC4Z ,
LIC
WATER HEATER LICENSE NO. CLASS d
GAS SYSTEM OUTLETS DISTRICT NO. GROUP I NE OC S D BY
OUTLETS OVER
OU % #'�-
5 PER SYSTEMV
INDUSTRIAL
WASTE APPROVAL �y
INSPECTION RECORD N
Plan check fee
PLUMBING PERMIT ISSUING FEE $
TOTAL FEE
Plan check applicant
Name APPROVALS DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
Address ROUGH PLUMBING
City Tel. No GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER '
PLUMBING.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSEDAS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALI FORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO
RESIDE IN THE ABOVE DESCRIBED RESIDE TI L PROPERTY. UTILITY CO NOTIFIED
SIGNATU RE
OF PERMITTEE i FINAL -/7�
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK' O: CASH