HomeMy Public PortalAbout9154 WOOLLEY ST_Plumbing__ 76A667A ICE B17B)-11/76
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APPLICATION FOR PLUMBING PERMIT
BUILDING AN SAFETY DIVISION
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
NUMBER FIXTURE OR ITEM ® FEE
ADDRESS �JU
WATER CLOSET LOCALITY em
NEAREST
BATH TUB CROSS ST.
SHOWER 3 OWNER
MAIL
LAVATORY 13 ADDRESS I i
SINK CITY aLt CiTEL.NO.
DISHWASHER CONTRACTOR
CLOTHES WASHER
ADDRESS•
pep
SWIMMING POOL RECEPTOR
CITY h4lvTEL.NO. .
LAWN SPRINKLER SYSTEM
STATE LIC.
WATER HEATER LICENSE NO. CLASS
GAS SYSTEM OUTLETS DISTRICT NO: GROUP ZONE PROCESSED BY
OUTLETS OVER
5 PER SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD in
ub
Plan-check fee
PLUMBING PERMIT ISSUING FEE$ -p
TOTAL FEE Al
Plan check applicdvt
APPROVALS DATE INSPECTOR'S SIGNATURE
Name
UNDER SLAB WORK
Address ROUGH PLUMBING
City I.No. GAS PIPING
1 HEREBY ACKNOWLEDGE THAT.(HAVE READ THIS APPLICATION AND STATE GAS VENT _
THATTHE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE-LAWS REGULATING PLUMBING. HOT WATER HEATER
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE GAS TEST
LEGAL OWNER OF.AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL
PROPERTY. UTILITY CO.NOTIFIED
J i
SIGNATURE �
OF PERM ITTE FINAL Z.�� �,7// .•F�!
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PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M<]
2 4 5 LIZOOV 21 5 D 135 Q Ard
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