HomeMy Public PortalAbout5325 1/2 SANTA ANITA AVE_Plumbing__ 7GAG57C (CE-8179) -8/75 C-Z-v- '
APPLICATION FOR PLUMBING PERMIT
BUILDING AND SAFETY DIVISIONv ;L
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FOR APPLICANT TO FILL.IN (PRINT OR TYPE) BUILDING .�. r
NUMBER FIXTURE OR ITEM @ FEE ADDRESS
WATER CLOSET LOCALITY
BATH TUB CROSS ST.NEAREST
SHOWER OWNER YQ
LAVATORY MAI L
ADDRESS o v
SINK CITY TEL. NO.K Q
DISHWASHER CONTRACTOR
CLOTHES WASHER
ADDRESS
SWIMMING POOL RECEPTOR
. CITY TEL. NO.
LAWN SPRINKLER SYSTEM
STATELIC -
WATER HEATER LICENSE NO. 6 -� CLASS o}
GAS SYSTEM OUTLETS DISTRICT NO. GROUP ZONE RIO SED BY O
OUTLETS OVER CD
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5 PER SYSTEM INDUSTRIAL ~
WASTE APPROVAL yvl
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INSPECTION RECORD
Plan check fee
PLUMBING PERMIT ISSUING FEE $ 1�
TOTAL FEE
Plan check applicant
Name APPROVALS DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
Address ROUGH PLUMBING _
City Tel. NO. GAS PIPING
IHEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT ! r v-
AND STATE THAT THEABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF, AND INTEND TO
RESIDE IN THE ABOVE DESCRIBED R SID oRBR.T,Y. UTILITY CO. NOTIFIED
SIGNATURE \1. 1
OF PERMITTEE vim➢ 1 FINAL
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PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
0.2 3.C`-0CT- 2.9 5 u 1 35 0. A-Lfb