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HomeMy WebLinkAbout7415A76A667A CE 677 (REV. 6/78) ©S APPLICATIONh SAFETYCOUNTY OF LOS ANGELES BUILDING AND FOR APPLICANT TO FILL IN (PRINT OR TYPEI BUILDINGS�-,�" ADDRESS r`"- g� x{r r''. `'w; /'.w%f`:_. } ,. NUMBER FIXTURE OR ITEM @ FEE S LOCALITY », WATER CLOSET NEAREST CROSS ST.l a BATH TUB OWNER SHOWER LAVATORY MAIL �' ADDRESS �i , SINK CITY r: TEL. N t -` DISHWASHER CONTRACTOR -, CLOTHES WASHER ADDRESS SWIMMING POOL RECEPTOR CITY TEL, NO. LAWN SPRINKLER SYSTEM STATE LICENSE NO. LIC. CLASS WATER HEATER APPROVALS DATE INSPECTOR'S SIGNATURE GAS SYSTEM OUTLETS UNDER SLAB WORK OUTLETS OVER 5 PER SYSTEM ROUGH PLUMBING GAS PIPING GAS VENT HOT WATER HEATER PLUMBING FIXTURES GAS TEST Plan check fee UTILITY CO. NOTIFIED PLUMBING PERMIT ISSUING FEE $ o TOTAL FEE FINAL PLAN CHECK VALIDATION PERMIT VALIDATION Plan check applicant Name Address City Tel, No. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE 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. 0- SIGNATURE OF PERM ITTEE DISTRICT NO. PROCESSED BY INDUSTRIAL WASTE APPROVAL