HomeMy WebLinkAbout1835 Forest Ave; ; 71-529; PermitPLUMBING PERMIT APPLICATION
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City of CARLSBAD, CALIFORNIA
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LICENSE NO. ~ ----~ ~ ' '
LICENSE NO. ... " ~ ~ ~
81111:ANCH ~ ~ ...
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ENGINEER MAI L ADDl'II: ESS PHONE
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LENDER MAIL ADDIIIESS
USE OP' BUI LDI NG ·~
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8 Class of work: NEW O ADDITIO,/" 0 ALTERATION /JO REPAIR
9 Describe work: -
PERMIT FEES
No. Type of Fixture or Item Fee
SPECIAL CONDITIONS: WATER CLOSET (TOILET) $
BATHTUB
LAVATORY (WASH BASIN)
SHOWER
KITCHEN SINK & DISP.
DISHWASHER
APPLICATION ACCEPTED BY: PLANS CHECKED BY:
APPRO~EDFO~SSUANCE BY:l-~~--1---=.LA.=.._U_N_D~R-Y~T-R_A_Y~~~~~~~~~~~~~~l--~-4-~~ r ,I'\..../ CLOTHES WASHER
WATER HEATER
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-
MENCED.
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS
T YPE 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 STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
SIGtTURE OF" CON Tl'll:ACTO" OR AUTHORIZED AGENT !DATE)
URINAL
DRINKING FOUNTAIN
FLOOR-SINK OR DRAIN
SLOP SINK
GASSYSTEMS:NO.OUTLETS
WATER PIPING & TREATING EQUIP.
WASTE INTERCEPTOR
VACUUM BREAKERS
LAWN SPRINKLER SYSTEM
SEWER
CESSPOOL
SEPTIC TANK & PIT
PERMIT
SIGNATURE OP' OWNER tlP' OW·N ER BUILDER IDAT[) TOTAL FEE
WHEN PROPERLY VALIDATED (IN THIS SPACEI THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. M.o. CASH PERMIT VALIDATION CK. M.O.
INSPECTOR
"I;'" o 0
S Y~o
CASH
IIC'l"IDl"\C'II «-•t'u..A• l"'-ITt='RN.6.TIONAL CONFERENC E OF BUILDING OFFICIALS e eo so. L OS P'l:OBLES e PASADENA. CALIP'ORNIA 01 101
CITY OF CARI.SBA[ SEWER
BUILDING DEPARTMENT PERMIT • APPLICATION
FOR APPLICANT TO FILL IN
LEGAL BUILDING DESCRIPTION LOT NO. ADDRESS
BLOCK TRACT NEAREST
CROSS ST. USE OF
BUILDINGS OWNER
MAIL CONTRACTOR ADDRESS
ADDRESS CITY TEL. NO.
CITY TEL. NO. CONNECTION DATA
CONTRACTOR"& STATE CARLSBAD BUSINESS Lateral Charge Computation
LICENSE NO. LICENSE NO.
30' H., 10' V. @ 4" = __ 6" -----
Add. Horiz. @ 4" = ___ 6" -NO. DESCRIPTION OF WORK FEE ----
HOUSE SEWER CONNECTING TO Add. Vert. @ 4" = 6" -PUBLIC SEWER • 13.00 ------
SEPTIC TANK, SEEPAGE PIT OR T otel Construction Cost PITS 0 111.00 ,___
OVERFLOW SEEPAGE PIT, DRAINFIELD EXTN., 1oro Service Charge CESSPOOL, DRYWELL. MANHOLE • 111.00
HOUSE SEWER CONNECTING TO Total L11ter11I Ch11rge PRIVATE DISPOSAL SYSTEM • 11.110 ,___
CONNECT ADDITIONAL BLDG. OR L11t. No.: Logged in Pl11t: WORK TO HOUSE SEWER • 11.110
ALTER. REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM 0 12.00 LINE COST DATA
• I A. D. & Assmt. No .
LINE COST:
OWNER'S I PERMIT $ a 00 C. C. @ __ I dwelling
AUTHORIZATION TOTAL P'IEE P. S. @ __ / dwelling
OTHER I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED BUILD· TOTAL ING TO THE PUBLIC SEWER.
SIGNED THIS
OWNER OR
DAY OF Gr11nd Tot11I, L11ter11I, etc.
OWNER'S AGENT FOR SEWER LOCATION ADDRESS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT ..: ..: AND AGREE TO COMPLY WITH ALL CITY ORDINANCES AND ..,, ..,,
STATE LAWS REGULATING PLUMBING AND SEWERS. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY THE CITY OF CARLS•
BAD AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL St. NORTH
OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROP.. ENGINEERING SEWER DEPT. ERTY.
SIGNATURE Signed I Signed OF PERMITTEE
This is • Sewer Permit When Properly Filled Out, Signed and Validated
Issued By --------------------
PERMIT VALIDATION