HomeMy Public PortalAbout5625 1/2 WELLAND AVE_Plumbing__ 7GA667 (C6-917) - 1/78 '
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i • APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY-ENGINEER
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO'. BUILDING,
ADDRESS. '
HARVEY T. BRANDT, COUNTY,ENGINEER LOCALITY
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FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST - 16
NUMBER FIXTURE OR ITEM @ FEE CROSS ST.
WATER CLOSET
2.00 OWNER
MAIL
BATH TUB 2.00 ADDRESS
SHOWER 2.00 CITY TEL. NO. '
LAVATORY 2.00 CONTRACTOR
SINK 2.00 ADDRESS $ Q
DISHWASHER 2.00 CITY TEL. NO,
CLOTHES WASHER 2.00 STATE LIC
SWIMMING POOL RECEPTOR LICENSE NO. CLASS
2.00
DISTRICT NO.GROUP ZONE PROCESSED BY
LAWN SPRINKLER SYSTEM 2,00 !0 �.�
WATER HEATER 2.00 IND USIAL
WASTE ATRPPROVAL
GAS SYSTEM OUTLETS' 2.00a
OUTLETS OVER INSPECTION RECORD" v
5 PER SYSTEM. .30 ,3 epvr
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Plan check fee Sae Reverse
PLUMBING PERMIT ISSUING FEE $
TOTAL FEE
APPROVALS DATE INBPPVOWS SIGNATURE
Plan'check applicant UNDER'SLAB WORK
Name ROUGH PLUMBING v_ R�
AddeeBS GAS PIPING oS 9-
City Tel. No., GAS VENT
HOT WATER HEATER
'.I 'HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND. STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH. ALL COUNTY ORDINANCES AND STATE LAWS REGULATING `
r
PLUMBING. GAS TEST C
I HEREBY CERTIFY THAT I" AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED .
LICENSED. AS RECUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND. fRYtffb TO
RESIDE IN THE ABOVE ESCRIBED RESIDENTIAL PROPERTY. FINAL
SIGNATU RE
OF PERMITTEE
PERMIT VALIDATION v CK. M.D: CASH
PLAN CHECK VALIDATI N CK. M:O: CASH -
3 6 0r`_'FFR 45 V : '°