HomeMy Public PortalAbout5435 MCCULLOCH AVE_Plumbing__ APPLICATION FOR PLUMBING PERMIT
BUIL 1 G AND SAFETY DI ON
FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS N0 a MC (.°ULLOCH
NUMBER FIXTURE OR ITEM ® FEE LOCALITY � Ci ITX
WATER CLOSET
NEAREST
BATH TUB CROSS ST. QIiC►y
SHOWER OWNER BOB 0
NROY
LAVATORY MAIL
ADDRESS 5+35 NO. MC CULLOCH
SINK CITYZ CITY TEL.NO.
4-4641
DISHWASHER CONTRACTOR
CLOTHES WASHER AQUATIC MOTS
ADDRESS 101 E. HUNTINGTON .DRIVE
SWIMMING POOL RECEPTOR - '
CITY AR a�D TEL.NO.
LAWN SPRINKLER SYSTEM STATEC
C.
WATER HEATER LICENSE NO. 620 ASS Oi
GAS SYSTEM OUTLETS DISTRICT NO. a T USP! ZON P ESSED BY -
OUTLETS.OVER
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SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
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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 jel.No. GAS PIPING
1 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 CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS UMBING FIXTURES
REQUIRED BY LOS ANGELES COUNTY AND STATE CALIFORNIA OR THAT I AM THE $TEST e
LEGAL OWNER OF,AND I TO RESIDE IN BOVE ED ID TI
PROPERTY. -UTILITY CC).NOTIFIED
SIGNATURE
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FPERMITTEE FINAL / / b
k,Tlo GUY'ME
BIZ c PERMIT VALIDATION CK. M.0. CASH
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