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HomeMy WebLinkAboutNo Permit Number76A667A CE 817 (Rf �`L 6/78) ©s APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES WILDING AND SAFETY FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING 'ADDRESS Q NUMBER FIXTURE OR ITEM @ FEE LOCALITY WATER CLOSET NEAREST CROSSST.k EE -P BATH TUB OWNER q T SHOWER LAVATORY MAIL ADDRESS SINK . CITY TEL. NO. -•- a, DISHWASHER CONTRACTOR CLOTHES WASHER ADDRESS 1 SWIMMING POOL RECEPTOR CITY„ TEL. NOSik ' s LAWN SPRINKLER SYSTEM STATE LIC. LICENSE NO. 's ' ` CLASS C WATER HEATER ,j GAS SYSTEM OUTLETS or DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK OUTLETS OVER 5 PER SYSTEM ROUGH PLUMBING GAS PIPING 'i GAS VENT HOT WATER HEATER. PLUMBING FIXTURES GAS TEST 1-0 1 Plan Check fee UTILITY CO. NOTIFIED PLUMBING PERMIT ISSUING FEE $Cg TOTAL FEE /j e7e FINAL PLAN CHECK VALIDATON Plan check applicant S) 7 Name/. Address City Tel. No. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THATTHE 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 OFPERMITTEE DISTRICT NO. POCESSED BY INDUSTRIAL WASTE APPROVAL PERMIT VALIDATION f'