HomeMy WebLinkAbout1355 FOREST AVE; ; 76-343; Permit0 {~)
PLUMBING PERMIT APPLICATION
City of CARLSBAD, CALIFORNIA
Applicant to complete numbered spaces only Perm it No,
JOB AOOR ESS
t ...-5 ;' I T~ACT
OWNE .. MAIL ADDRESS ll p PHONE
2 ~ I ~{ ,\, ,-' ~
CONTAACTOA ' MAIL ADOAESS PHOHE LICENSE NO.
3
.... I CHITECT OA OESIGNEA MAIL A.OOA[.55
4
£.NCINEER MAIL ADDRESS
5
COMPENSATION (NS. CARRIER MAIL ADDIIIESS
6
US£ 01" &UI LDING
7
8 Class of work: O NEW 0 ADDITION 0 ALTERATION
'l Describe work: .c, 0 v ~ ~ c:...;
SPECIAL CONDITIONS:
APPLICATION ACCEPTEO ev PLANS CHECKED BY APPROVED FOR ISSUANCE BY
DATE
NOTICE
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC·
TION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM·
MEN CED
I HEREBY CERTIFY THAT I HAVE READ ANO EXAMI NED THIS APPLICATION ANO KNOW THE SAME TO BE TRUE ANO CO RRECT
ALL PROVISIONS OF LAWS ANO ORDINANCES GOVERNING THIS TYPE O F 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 OTH ER STATE OR LOCAL LAW REGULATING
CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
(DAT£) SIGN,UflU. or CONT,.ACTO,t O,t 4UT:O"t?EO AGtNT
; f"'\.-tf.... "'"' ..:: -
SIGNATU"I~ OP' OWN[" tlP' OWNt R 8Ult.O[R) OAT£.
PHONE LICENSE NO,
PHONE LICENSE NO,
&IU,NCH
0 REPAIR
PERMIT FEES
No. Type of Fixture or Item
WATER CLOSET (TOILET)
BATHTUB
LAVATORY (WASH BASIN)
SHOWER
K ITCHEN SINK & DISP.
DISHWASHER
LAUNDRY TRAY
CLOTHES WASHER
WATER HEATER
URINAL
DRINKING FOUNTAIN
FLOOR -SINK OR DRAIN
SLOP SINK
GASSYSTEMS NO.OUTLETS
WATER PIPING & TREATING EQUIP.
WASTE INTERCEPTOR
VACUUM BREAKERS
LAWN SPRINKLER SYSTEM
7 SEWER
CESSPOOL
SEPTIC TANK & PIT
ROOF DRAINS
PERMIT
TOTAL FEE
WHEN PROPERLY VALIDATED UN THIS SPACE) THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. M.O . CASH PERMIT VALIDATION CK. M.O.
(,_
INSPECTOR
52ti-• ••12.50
'-
ST ATE C I TY
Fee
$
$ J .. 11 IV
$, __ ~)
CASH
INSPECTION REPORTS
DATE ITEM REMARKS INSPECTOR
6-t-7~ ,A/,·~., ~---~ ~R. £ ,.,,, ~ ------
'"'?11,19-LL .L_-z~. ~-/~/d ,:;I' ?:"»'~ ., V -/ -
USE SPACE BELOW FOR NOTES, FOLLOW-UP, ETC.
APPLICATION FOR PERMIT TO CONNECT TO CITY SEWER SYSTEM
CITY OF CARLSBAD
ENGINEERING DEPARTMENT
729-1181 EXT. 35
FOR APPLICANT TO FILL IN
BUI LDING
ADDRESS
OWNER
MAILING
ADDRESS
CONTRACTOR
CONTRACTOR'S
ADDRESS
11
NEW BUILDING EXISTING BUILDING
LEGAL DESCR IPTION
l t r
REMARKS:
LATERA L LOCATION
ST.
I
i-= Cl)
LATERAL NO, _______ INSTA LLATION DATE------~
_> SE 1748 BUILDING DEPT.
ISSUED BY ____ ....:..:..==-..:.~--=----'--.:.......:-'---=--------
DATE ISSUED----"-----'.._,_=--------------
VALIDATION
LATERA L CHARGE COMPUT ATION
STA NDARD 4" (Max. H. 30'. V. 10') _________ _
OVER 30' H. ___ @,,,,.__ ___ FT. _________ _
OVER10'V. @ FT. __ ;__;___;___--'-'---
STANDARD 6" (Max. H. 30', V. 10') _________ _
OVER 30' H. ___ @,,__ ___ FT·----------
OVER 10' V. @ FT.----------
TOTAL CONSTRUCTIO N COST----------
SERVICE CHARGE (REPAVIN G ETC.) _________ _
TOTAL LATE RAL CHARGE----------
LINE COST DATA
ASSESSMENT DIST. NO.--------------
FRONTAGE ____ COST PER FT. ____ TOTAL __ _
OTHER ___________ ___;;__ ___ __,,---,--
CONNECTION FEE
NO. UNITS_"'--_COST PE R UNIT ___ TOTAL---
PUMP STATION FEES
NO. UNITS ___ COST PER UNIT ____ TOTAL---
k716<)
TOTAL CHARGES (LATERAL ETC.>------~J.J......,V=---