HomeMy Public PortalAbout6016 KAUFFMAN AVE_Plumbing__ 7GA667A I Ck-817B) -4/77
• APPLICATION FOR PLUMBING PERMIT
BUILDING SAFETY DIVISION
FOR APPLICANT TO FILL IN(PRINT OR TYPEI BUILDING O
NUM ER FIXTURE OR ITEM @ FEE ADDRESS
WATER CLOSET LOCALITY
BATH TUB NEARESTCROSS ST
SHOWER OWNER
LAVATORY - MAIL
ADDRESS
SINK 3 CITY
ANO
DISHWASHER M11 CONTRACTO
CLOTHES WASHER
ADDRESS
SWIMMING POOL RECEPTOR17
,
CITY TEL NOfA ! /
LAWN SPRINKLER SYSTEM
STATE LIC
WATER HEATER LICEN O �QG CLASS y
GAS SYSTEM OUTLETS CT NO GROUP NEPROC fD
OUTLETS OVER L v
5 PER SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD O�
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Plan check fee
PLUMBING PERMIT ISSUING FEE$
TOTALFEE
Plan check applicant
APPROVALS DATE INSPECTOR'S SIGNATURE
Name
• UNDER SLAB WORK
Address ROUGH PLUMBING
City Tel No. GAS PIPING %6
I-HEREBY-ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION-AND STATE `GASVENT--
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 CALIFOR A OR THAT I AM THE GAS TEST ' -
LEGAL OWNER OF,AND INTEND TO RESIDE IN THE ABOV RIBED YSIDENTIAL
PROPERTY UTILITY CO.NOTIFIED
/
SIGNATURE
OF PERMITTEE FINAL
PLAN CHECK VALIDATIO M o CASH PERMIT VALIDATION cK M.O CASH
55 -DEC "I 5 D 37.50 ®LV