HomeMy Public PortalAbout5623 1/2 WELLAND AVE_Plumbing__ 76AG67 (CB-317) - 1/75
APPLICATION FOR PLUMBING PERMIT
� COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISIONBUILDING c. r,
MAKE CHECKS PAYABLE TO: ADDRESS (/�/
HARVEY T. BRANDT, COUNTY ENGINEER
LOCALITY r
FOR APPLICANT TO FILL IN (PRINT OR TYPE1 NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM @FEE
2.00 OWNER
WATER CLOSET (f /
MAIL / w
BATH TUB 2.00 : ADDRESS'
SHOWER 2.00 CITY TEL. NO.
LAVATORY 2.00 o CONTRACT
SINK 2;00 ADDRESS
DISHWASHER 2.00 CITY TEL. NO
CLOTHES WASHER 2.00 STATE' LIC
LICENSE NO. CLASS
SWIMMING POOL RECEPTOR 2.00
D.ISTRI'CT NO.GROUP ZONE PROCESSED BY
LAWN SPRINKLER SYSTEM 2.00 r
WATER HEATER 2.00 INDUSTRIAL
WASTE APPROVAL
GAS SYSTEM OUTLETS 2.00a
INSPECTION RECORD
OUTLETS OVER C7
5 PER SYSTEMA .30 �Ja-Z� 1�� d� v
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Lu
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93-
0013
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Flan check fee See Reverse
PLUMBING PERMIT ISSUING FEE S
TOTAL. FEE `
,Plan check applicant �� � APPROVALS DATE INSPECSOR'S SIGNATURE
16 UNDER SLAB WORK'
Name ROUGH PLUMBING
Address GAS PIPING
I
City Tel. No. GAS VENT '
HOT WATER HEATER
I HEREBY ACKNOWLEDGE THAT I RAVE READ THISAPPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND -STATE'LAWS REGULATING �.�. -' -
PLUMBING. GAS TEST 6 s� rsog 007
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED -
LICENSED AS RE7U.IRED BY LOS ANGELES COUNTY AND STATE OF -
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF, AND IATENb TO _
RESIDE IN THE ABOVE.DESCRIBED RESIDENTIAL PROPERTY. FINAL /� � Ja.,.,�••,
SIGNATU RE
OF PERMITTEE
PERMIT VALIDATION CK. M.o: CASH
.PLAN CHECK VALIDA ON CK. M.O. CASH
3 7 9�-FE8 2..5 U -1:8