HomeMy Public PortalAbout5417 SANTA ANITA AVE_Plumbing__ CE�17(REV.11/78)�
APPLICATION FOR. PLUMBING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ,( '
NUMBER FIXTURE OR ITEM ® FEE ADDRESS ✓ ✓�I/V/4
WATER CLOSET LOCALITY `� Ci Z�oe
NEAREST
BATH TUB CROSS ST.�Z—
SHOWER OWNER
LAVATORY MAIL /
ADDRESS / IC fl
SINK 31 CITY -� TEL.NO.
DISHWASHER CONTRACTOR
CLOTHES WASHERCA
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ADDRESS / W /C
SWIMMING POOL RECEPTOR p
CITY �. (� TEL.NO: O r.-
LAWN SPRINKLER SYSTEM TATF LIC.
WATER HEATER LICENSE NO. lrx-z� CLASS.e-
/ GAS SYSTEM OUTLETS 3 APPROVALS DTE o INS_FkJPV SIGNATURE
OUTLETS OVER UNDER SLAB WORK
5 PER SYSTEM ROUGH PLUMBING
GAS PIPING 0
GAS VENT 0
HOT WATER HEATER 2
PLUMBING FIXTURES a pij
GAS TEST v y
Plan check fee
UTILITY CO.NOTIFIED
PLUMBING PERMIT ISSUING FEE$
TOTAL FEEFINAL m
Plan check applicant 113ZPLAN CHECK VALIDATION
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Name
Address e 7'5 9.4 A
City Tel.No.
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE # o o O o o5
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING. PERMIT VALIDATION 2 0 - 37.00
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE �o O o37,0050
LEGAL OWNER OF.AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL
PROPERTY. , 11,05' 79
SIGNATURE
OF PERMITTEE
'DISTRICT NO. P CESSED BY
✓/
NDUSTRIAL
HASTE APPROVAL