HomeMy Public PortalAbout5453 MCCULLOCH AVE_Plumbing__ 75AG67A(CES17A) - 8/75
APPLICATION FO LUMBI PERMIT
COUNTY OF IAS ANGELES.
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
MAKE GHEClCS PAYABLE TO: BUILDING / � ��c? e
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HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY �+
PPLICANT TO FILL IN (PRINT OR TYPE) NEARESTCROSS ST.F7FOR
FIXTURE OR ITEM FEE R CLOSET 9OWNER
MAIL
TUB ADDRESS
SHOWER CITY. TEL. NO�d
LAVATORY
Q CONTRACTOR"
SINK ADDRESS /�lO
DISHWASHER CITY TEL. NO.
CLOTHES WASHERSTATE LIC
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SWIMMING POOL RECEPTOR LICENSE NO. Af f-I CLASS Cr
DI TRICT NO. G?ROUP E CESSED BY
LAWN SPRINKLER SYSTEM a _Y _ �,%
WATER HEATER6O' WASTINDUSTR
E APPROVALIAL
a GAS SYSTEM OUTLETS INSPECTION RECORD
OUTLETS OVER 10.
.
.5 PER SYSTEM
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Plan check fee See Reverse
PLUMBING PERMIT ISSUI G FEE $
TAL FEEsp .
APPROVALS DATE INSPECTOR'S SIGNATURE
Plan Check applicant UNDER SLAB WORK
Name ROUGH PLUMBING �''►-r
Address GAS PIPING
City Tel. No. GAS VENT
HOT WATER HEATER
I HEREBY.ACKNOWLEDGE THAT 1 HAVE. READ THIS APPLICATION
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY PLUMBING FI URES
WITH ALL COUNTY ORDINANCES .AND STATE LAWS REGULATING
PLUMBING. GAS TEST
1 HEREBY CERTIFY THAT I AM'PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED
LICENSED 'AS REQUIRED BY LOS ANGELES COUNTY AND STATE-OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO
RESIDE IN THE'ABOVE bESC BED RESIDENTI PRO PI:RTY. . FINAL � ,,
t
SIGNATU RE
OF PERMITTEE
PERMIT VALIDATION cK.
3. M.O. CASH
PLAN CHECK VALIDATION CK. M.O. CASH ��
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