HomeMy WebLinkAbout2858 CARLSBAD BLVD; ; 76-4187; PermitPLUMBING PERMIT APPLICATION
City of CARLSBAD, CALIFORNIA
Applicant to complete numbered spaces only.Permit No.
JOB ADDR ESS 4fe€feCfi Rtev^l 4%^M4 HA V^
LOT NO. BLK - TRACT
. LEGAL
1 DESCR.
OWNER • • • MAIL AODBCSS
2 FOQCUTTKR 285^ CtarXafead HEwd*Gariafeaft, Ca. 92*06 729-3189
CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. STATE C TV
3 BOBS FiBMBDK} SfltYXQB 2500. State St* Carlabad Ca. 729-2055 2*570? 93*3
ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO.
4
ENGINEER , - .MAIL ADDRESS PHONE LICENSE NO.
5
COMPENSATION fNS. CARRIER MAIL ADDRESS BflANCH
6 State iBwnaa* Caapanaatlatt Fund F. 0. 80*88 San Daifo, Ca*
USE OP BUILDING
7
8 Class of work: D NEW D ADDITION D ALTERATION D REPAIR
9 Describe work: iwEtLaa* watar haatap
* , '. *'•• 1* <*"-' •
SPECIAL CONDITIONS:
APPLICATION ACCEPTED 8V PLANS CHECKED BV APPROVED FOR ISSUANCE 8Y
/ •/ 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-
MENCED.
1 HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS
APPLICATION AND KNOW THE SAME TO 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 STATE OR LOCAL LAW REGULATINGCONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
10/25/76
SIGNATURE OF CONTRACTOR OH AUTHORIZED AGENT (DATEI
SIGNATURE OF OWNER (IF OWNER BUILDEBJ (DATE)
fi . , PERMIT FEES
No.Type of Fixture or Item
WATER CLOSET (TOILET)
BATHTUB
LAVATORY (WASH BASIN)
SHOWER
KITCHEN SINK & DI5P.
DISHWASHER
LAUNDRY TRAY
CLOTHES WASHER
WATER HEATER
URINAL
DRINKING FOUNTAIN
FLOOR—SINK. OR DRAIN
SLOP SINK
GAS SYSTEMS: NO- OUTLETS
WATER PIPING & TREATING EQUIP.
WASTE INTERCEPTOR
VACUUM BREAKERS
LAWN SPRINKLER SYSTEM
SEWER
CESSPOOL
SEPTIC TANK & PIT
ROOF DRAINS
PERMIT $
TOTAL FEE $
Fee
$
9_
50
00
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK.M.O.CASH PERMIT VALIDATION CK.M.O.CASH
INSPECTOR