HomeMy Public PortalAbout5333 LOMA AVE_Plumbing__ 76A667 (CE-817) - 175 "
APPLICATI N OR PLUMBING PER 1T .
COUNTY OF LOS ANGELES
DEPARTMENT.OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO. BUILDING
ADDRESS
HARVEY T. BRANDT, COUNTY ENGINEER LOCALI
FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST
NUMBER FIXTURE OR ITEM @ FEE CROSS ST.
WATER CLOSET 0
OWNSMAIL
- BATH TUB 0 ADDRESS t63
SHOWER p C .giC1 4 TEL. NO
LAVATORY 2 CONTRACTOR
SINK 2.VO ADDRESS
DISHWASHER 2.AO CIT TEL. NO
CLOTHES WASHER 2. STATE / OG rye LIC /1
LICENSE NO. [ 0 / O_ CLASS/ �J
SWIMMING POOL RECEPTOR 2 1
DISTRICT N0.1GROUPI ZONE r PR CESSED BY
LAWN SPRINKLER SYSTEM .00 5-J0j2J �pv -----J
WATER HEATER .00 INDUSTRIAL
WASTE APPROVAL a
GAS SYSTEM OUTLETS .00INSPECTION RECORD U
OUTLETS OVER CC
5 PER SYSTEM O
W
CL.
Z
Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEE $
TOTAL FEE '
APPROVALS DATE INSPECTOR'S SIGNATURE
re
check applicant UNDER SLAB WORK
ROUGH PLUMBING
ss GAS PIPING
Tel. NO. GAS VENT
HOT WATER HEATER
EREBY ACKNOWLEDGE THAT 1 HAVE READ .THIS APPLICATION
TATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES !'
ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ING. GAS TEST -
EREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED
ED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
RNIA OR THAT I AM THELEGAL OWNER OF, AND INYEND TO
IN THE ABOVE DESCRIBED RF�'y�ENTIAL PROPERTYFINALATURE /L/fie/,PERMITTEE
PERMIT VALIDATION 'C1. M.0. CASH
PLAN CHECK VALIDATION CK. M.0. CASH
" , 7 6 A 6 6 7 ' - C E B 1 7 5 / 7 0
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