HomeMy Public PortalAbout5415 SANTA ANITA AVE_Plumbing__ � 7A
CE'917 RE)/.11✓78)
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
ADDRESS
NUMBER FIXTURE OR ITEM ® FEE
WATER CLOSET LOCALITY
NEAREST
BATH TUB CROSS ST.
SHOWER OWNER a{� Wei.44Deem
MAIL
LAVATORY ADDRESS l
SINK CITY'^ r e. TEL.NO.
DISHWASHER CONTRACTOR LS
CLOTHES WASHER 3 ADDRESS
SWIMMING POOL RECEPTOR u
CITY TEL.NO '7 Cj
LAWN SPRINKLER SYSTEM STATEp
WATER HEATER LICENSE NO..Fie 2 V CLASS
GAS SYSTEM OUTLETS 3 APPROVALS DATE INs CT 'S SIGNATURE
OUTLETS OVER UNDER SLAB WOR ff
5 PER SYSTEM ROUGH PLUMBING
GAS PIPING
GAS VENT ps
HOT WATER HEATER
PLUMBING FIXTURES
GAS TEST V AjAPA
Plan check fee UTILITY CO.NOT TIED
PLUMBING PERMIT ISSUING FEE$ t
TOTAL FEE FINAL
PLAN CHECK VALIDATION
Plan check applicant n rU.7� �.T —76:;OT '4wC y ffA-
Name /` 7
Address T5 9.3 A
City Tel.No. # o o 10 0 o 5
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE O p o37.00 Z 7 O O
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES L iJ I
AND STATE LAWS REGULATING PLUMBING. PERMIT VALIDATION �7
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS -- 3 ,0006
!
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE
LEGAL OWNER OF.AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL t �,Q 5 7 9
PROPERTY.
•
SIGNATURE
OF PERMITTEE,e
DISTRICT NO. OCESSED
INDUSTRIAL
WASTE APPROVAL