HomeMy Public PortalAbout9161 WOOLLEY ST_Plumbing__ 76AG67C (CE-61713) -9/79
J# APPLICATION FOR PLUMBING PERMIT {�
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BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN (PRINT OR TY PEI ADDRESS f(ic
NUMBER FIXTURE OR ITEM @ FEE
WATER CLOSET LOCALITY
NEAREST /Y
BATH TUB }�
CROSS ST. G�t/Y +�F
SHOWER OWNER' Vi s •e,r
LAVATORY MAIL
ADDRESS sv L�-E
SINK CITY =Afj1,tF TEL. NO.���a���
DISHWASHER CONTRACTOR
CLOTHES WASHER
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SWIMMING POOL RECEPTOR ADDRESS f� •
CITY TEL NO.
LAWN SPRINKLER SYSTEMSTATELIC
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WATER HEATER �7 L� LICENSE NO. Z Z 6 3 !! l CLASS d
GAS SYSTEM OUTLETS DISTRICT NO. GTROUP 7QNE I PROCESSED BY V
/ OUTLETS OVER �� e I y
5 PER SYSTEM CD
INDUSTRIAL V
WASTE APPROVAL yl
INSPECTION RECORD N
Z
Plan check fee
PLUMBING PERMIT ISSUING FEE $
TOTAL FEE Q
Plan check appli knt
NameAPPROVALS DATE INSPECTOR'S SIGNATURE
���jjJJ UNDER SLAB WORK
Address /G� /Gn.JGf=� ROUGH PLUMBING
City'71 f_ Tel. No-j f%S- ,_� GAS PIPING
I HEREBY ACKNOWLEDGE THAT/I HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THEABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY' ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO
RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO. NOTIFIED
SIGNATURE
OF PERMITTEEee22�� FINAL
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PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. < ASH ,
14. "MAR 15 .5 • 1s 0.5 0 .88
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