HomeMy Public PortalAbout6043 OAK AVE_Plumbing__ 76AS67A ICE 8178)-11/76 �� ' ��� •J�+.� ,
APPLICATION FOR PLUMBING PERMIT
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
ADDRESS
NUMBER FIXTURE OR ITEM. FEE
WATER CLOSET LOCALITY 7-�
BATH TUB NEAREST
CROSS ST. .C7
SHOWER OWNER ,
IC
LAVATORY MAIL
ADDRESS /. 06-k—
SINK CITY TEL.NO.
DISHWASHER CONTRACTOR W AJ
CLOTHES WASHER 300 ADDRESS
SWIMMING POOL RECEPTOR
CITYTEL.NO.
LAWN SPRINKLER SYSTEM
STATE LIC.
WATER HEATER LICENSE NO. CLASS
'GAS SYSTEM OUTLET ,jTRICE UP' ED
OUTLETS OVER 3 IV.ICT
o
5 PER SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD in
4A
Plan cb.eck fee
PLUMBING PERMIT ISSUING FEE$ 5
TOTAL FEE
Plan check applicant
APP VhLS DATE INSEOZORPS SIGNATURE
Name UNDER ORK - V-77
Address ROUGH PLUMBING
City Tel.No. GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT
THAT THEA BOVE 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 PLUMBING FIXTURES
REOUIRED BY LOS ANGELES COUNTY AND STATE OF.CALIFORNIA OR THAT I AM THE GAS TEST-
LEGAL OWNER OF.AND INTEND TO RESIDE IN THE ABOVE DESCRIBED DENTIAL
PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE Q�
OFPERMITTEE -` FINAL
PLAN CHECK VALIDATION CK. MP.ec MIT VALIDATIQN O.50.5 () CK. M.O. CASH