HomeMy WebLinkAbout2515 VIA ASTUTO; ; 79-4574; PermitPLUMBING PERMIT APPLICATION
City of CARLSf3AD, CALIFORNIA 92008
Applicant to complete number" spaces only .,, Phone 729-1181 L,..,,;_.;., ·.,~.1r; Permit No,
JOB A.DOR ESS <
,; I Ul ,...(-... ' .J --.... ,
LOT NO. Im I T U CT LC OAL I 1 ouc~.
OWNCJII /" MAIL AODl'tC5S
2 \. L \ it {"' LA _, 1-\ i ' I -
ZI p PHONE
CON TflAC TOfl , •!, t, t I I , UI I \
MAIL. A.DORC55 STATE LIC, NO,
3
I ' \ b /,, s,J L\,.,._JI \
A "CHITCCT 0111 OCSICNCft h MAIL AODRCSS PHON[ LICCNSC NO,
4 \ )
CN GINCCR MAIL ADORCS5
5 ,;,
\
COMPENSATION (NS, CARRI ER MAlb '-00R£55
6
use OF ftUILOtNC
7
8 Class of work : 0 NEW 0 ADDITION 0 ALTERATION
9 Describe work:
SPECIAL CONDIT1ONS:
.·•
t
' APPLICATION ACCEPTED BY PLANS CHECKED BY APPROVED ,:QR ISSUANCE: BY.
DATE
PHON[
• I
LICEHS[ NO.
Bl'IANCH
0 REPAIR
t PERMIT FEES
No. Type of Fixture or Item
WATER CLOSET (TOILET)
BATHTUB
LAVATORY (WASH BASIN )
SHOWER
K ITCH EN SINK & D ISP.
DISH WASHER
L AUN DRY TRAY
CLOTHES WASHER
WATER HEATER
J
CITY LIC, NO,
Fee
$
NOT I c E,n. J __ -+-_u_R_1_N_A_L ________ '--------+---t---t
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC-41 DRINKING FOUNTAIN
TION AUTHORIZED I~ NOT COMMENCED Wl TH IN 1120 D A Yll.OR IF 1-----1-.!'-L_O_O_R_'--_S_i_N_K_O_R_D_R_A_I_N __________ +---+-7-i'
CONSTRUCTION OR \6'0RK IS SUSPENDED 0~ ABANDONEQ FOR A
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM-
MENCED.
I HEREBY CERTIFY THAT I HAVE READ ANO EXAMINED THIS APPLICATION AND KNOW THE SAME T O BE TRUE AND CORRECT.
ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS
TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER ST ATE OR LOCAL LAW REGULATING
CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
SIGNATURE: o,-CONTfltACTOIII OA AUTHOi.t2 E0 AC.CNT
~,! ,l, 1
(DAT£)
·--
(OAT£)
I:'
SLOP SINK
GAS SYSTEMS: N O.OUTLETS
WATER PIPING & TREATING EQUIP.
WASTE INTERCEPTOR
VACUUM B REAKERS
LAWN SPRINKLER SYSTEM
SEWE R NUMBER CLEANOUTS
CESSPO OL
SEPT IC TANK & PIT
ROOF DRAINS I
_{,· :s ISSUANCE FEE
.. TOTAL FEES
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK . M .O.
INSPECTOR
s
CASH
TL