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HomeMy Public PortalAbout6120 LOMA AVE_Plumbing__ 76A667A ....a CE IS 174REV.6/78) Js APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING NUMBER FIXTURE OR ITEM @ FEE ADDRESS LOCALITY WATER CLOSET NEAREST BATHTUB CROSS ST. t C SHOWER OWNER P, UT // LAVATORY MAILADDRESS VN, Yi SINK CITY ;. TEL.NO� )y DISHWASHER CONTRACTOR CLOTHES WASHER ADDRESS SWIMMING POOL RECEPTOR CITY NO. LAWN SPRINKLER SYSTEM STATE LIC. WATER HEATER LICENSE NO. CLASS GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR'S SIGNATURE OUTLETS OVER UNDER SLAB WORK 5 PER SYSTEM ROUGH PLUMBING GAS PIPING d GAS VENT G HOT WATER HEATER 0 PLUMBING FIXTURES 9 GAS TEST Plan check fee UTILITY CO.NOTIFIED PLUMBING PERMIT ISSUING FEE$ 17 � /✓ TOTAL FEE �0 FINAL PLAN CHECK VALIDA Plan check applicant TON / Name Address City Tel.No. z2 2'7 a,g A I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE fj THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES f O O 0 0 O 5 AND STATE LAWS REGULATING PLUMBING. PERMIT VALIDATION I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS 2 - - 1000 REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE - LEGAL OWNER OF,AND INTEND TO RESIDE IN THE ABOVE CRIBED RESIDENTIAL O .7 C Q a PROPERTY. _/) r(7 SIGNATURE °Gi� O r OF PERM ITTEE 6� DISTRICT NO. ROCESSE BY INDUSTRIAL WASTE APPROVAL