HomeMy Public PortalAbout9857 LEMON AVE_Plumbing__ 76A0e7A (CE 4/77
APPLICATION FOR PLUMBING PERMIT
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
NUMBER FIXTURE OR ITEM ® FEE ADDRESS
WATER CLOSET LOCALITY
NEAREST
BATH TUB CROSS ST
SHOWER OWNE C
LAVATORY MAIL J ��
ADDRESS
SINK CITY TEL NO
DISHWASHER CONTRACTOR
OAC
CLOTHES WASHER
ADDRES / J
SWIMMING POOL RECEPTOR
CITY TEL NO
LAWN SPRINKLER SYSTEM
STATELIC .7
WATER HEATER LICENSE NO —5,201W.0 CLASS �-
GAS SYSTEM OUTLETS DISTRICT NO I GROUP ZONE R ED BY
�—
OUTLETS QV ER
5 PER SYS EM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD CD
/ U
�j�.�i L'/ .ems 4/1✓� �/'k�f. y
Plan check fee
PLUMBING PERMIT ISSUING FEE$
TOTAL FEE
Plan check applicant
APPROVALS DATE INS CTOR'S SIGNATURE
Name �
UNDER SLAB WORK a 5/gqG''3�
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 C RTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES
REOU IRED OS AN S COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE GAS TEST
LEGAL OWNER OF AND IN ND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL
PROPERTY UTILITY CO NOTIFIED
SIGNATURE
OF PERM ITTE FINAL
I t
PLAN CHECK VALIDATION CK M o CASH4PE3VALIDATION CK M o CASH
6 2' 4- A5 A 3.0 0 ,690