HomeMy Public PortalAbout9828 WOODRUFF AVE_Plumbing__ 78A667A(CEO 17B)•11/76
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7 APPLICATION FOR PLUMBING PERMIT
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
NUMBER FIXTURE OR ITEM ® FEE ADDRESS
WATER CLOSET LOCALITY
BATH TUB NEAREST
CROSS ST;
SHOWER OWNER L�✓G'JS JjJ `7L['/
LAMAIL
�) ADDRESS &�/ /`,!1;k
SINKCITY TEL.NO:
B-(] Cl v -h//� d
DISHWASHER i 3-0--10 CONTRACTOR
CLOTHES WASHER " /
,ADDRESS/
SWIMMING POOL RECEPTOR CITY TEL.NO.94M-_
AWN SPRINKLER SYSTEM
WATER HEATER
STA CENSE NO. C.ASS
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GAS SYSTEM OUTLETS ^7. DISTRICT NO.. GROUP ZONE PROC ED BY
OUTLETS OVER S O
5•PER SYSTEM INDUSTRIAL
WASTE'APPROVAL
INSPECTION RECORD
us
Plan check fee
PLUMBING PERMIT ISSUING FEE$
TOTAL FEEQ
Plan check applicant
APPROVALS DATE INSPECTOWSSIGNATURE
Name UNDER SAB WORK -7
Address ROUGH PLUMBING
City Tel.Na. GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION ANU•STATE GAS-VENT
THATTHEABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES HOT WATER HEATER
AND STATE LAWS REGULATING PLUMBING. '
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSEDAS" PLUMBING FIXTURE$. . ,
REQUIRED BY LOS ANGELES COUNTY AND STATE aF CALIFORNIA OR THAT I'AM THE GAS TEST
LEGAL OWNER OF.AND INTEND TO RESIDE IN THE ABOVE.DESCRIBED RESIDENTIAL
PROPERTY. - UTILITY CO.NOTIFIED."
SIGNATURE -
CIFPERMITTEE AL - >�J�'�p
PLAN CHECK VALIDATION c . M.O: CASH PERMIT VALIDATION CK: O. CASH
,759 iZ SEP 1.3 5.. o ' 46.50 &,
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