HomeMy Public PortalAbout5715 OAK AVE_Plumbing_8/9/1979_OFr61]IREV.6/]el
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APPLICATIO FOR PL MBING PERMIT
COUNTY OF LOS ANGELES
FOR APPLICANT TO FILL IN (PRINT OR TYPEI
NUMBER FIXTURE OR ITEM
WATER CLOSET
BATH TUB
SHOWER
LAVATORY _
SINK ('&m/
DISHWASHER
CLOTHES WASHER
SWIMMING POOL RECEPTOR
LAWN SPRINKLER SYSTEM
WATER HEATER
r^ GAS SYSTEM OUTLETS
O PER R
SYSTEM
ETS OVER
5
Plan check fee
PLUMBING PERMIT ISSUING FEE $
TOTAL FEE
I Plan check applicant
Nome
Address
City
Lrawe.
BUILDING AND SAFETY
BUILDING
t ADDRESS
/ �• �/ /L� /A„i.
FEE
1 LOCALITY
NEAREST
I CROSS ST.
I OWNER
1MAIL
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3 �TCITY
I�A�DDRESS
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((CONTRACTOR
ADDRESS
CITY
STATE LIC.
LICENSE NO. CLASS
APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
ROUGH PLUMBING
GAS PIPING
GAS VENT
HOT WATER HEATER
PLUMBING FIXTURES
GAS TEST
UTILITY CO. NOTIFIED
1 1 Oji FINAL
PLAN CHECK VALIDATION V
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE
LEGAL OWNER OF, AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL
PROPERTY.
SIGNATURE
OF PERMITTEE
DISTRICT NM. � I ��CESSED BV
INDUSTRIAL Ay jI
WASTE APPROVAL / J
PERMIT VALIDATION ' 6 0 U. 8 A,
^( • . . . . J
2••1000
• • •
10003
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