HomeMy Public PortalAbout6028 SULTANA AVE_Plumbing__ 76A667C (CE-817H) -9/75 d V tJP1 C4,civf- .
APPLICATION. FOR PLUMBING PERMIT
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN (PRINT OR TYPEI BUILDING
NUMBER FIXTURE OR ITEM @ FEE ADDRESS �- (/LI A vu.
WATER CLOSET LOCALITY
BATH TUB NEAREST /)
CROSS ST.
SHOWER OWNER
LAVATORY MAIL
ADDRESS
SINK CITY TEL.
DISHWASHER CONTRACTOR
C-•
CLOTHES WASHER
ADDRESS
J SWIMMING POOL RECEPTOR �r
CITY TEL. NO. .(r-f�
LAWN SPRINKLER SYSTEM
STATEr LIC
WATER HEATER LICENSE NO. CLASS
DISTRICT NO. I GEtO�(P kZONE CES D BY v
GAS SYSTEM OUTLETS
OUTLETS OVER o�-Ir. �
O'
5 PER SYSTEM
INDUSTRIAL
WASTE APPROVAL W
INSPECTION RECORD Z
Plan check fee
PLUMBING PERMIT ISSUING FEE $ —v
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
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HD WATER HEATER
PLUMBING.
1 HEREBY CERTIFY THAT I M PROPERLY REGISTERED AND/OR PL MBI.NG FIXTURES
ILI
REQUIRED BY LES COUNTY AND STATE OF G S TEST
R THAT 1 AM E G L OWNER OF, AND INTEND TO
E ABOVE DES RES DENTIAaPERTY. ILITY CO. NOTIFIED
TTEE FINAL
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT V/IDATION CK. M.O. cases,
?. 4 8 DEC 14 5 1 3.5 0 ®�G
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