HomeMy WebLinkAbout21700 LAURELRIM DRIVE (4)76A667A (CE -817A)-4/72
APPLICATION FOR "PLL PE'MIT+
COUNTY OF LOS -ANGELES fl33tDEPARTMENTOFCOUNTYENGINEER
BUILDING AND SAFETY DIVISION
BUILDING •'e f' 1..
4ADDRESSG_/
LOCALITY D,,C4 ,t0—z L
FOR APPLICANT TO FILL IN(PRINT -DR TYPE( _... .._. NEARESTCROSSST. h. f
J
l
NUMBER FIXTURE OR ITEM 0. FEE
OWNER /Y •{/ R.T WATER CLOSET
BATH TUB ADDRESS 0 z C p
SHOWER CITY
42
TEL. NO.
LAVATORY CONTRACTOR /
7 !c' % /aa S [.
SINK ADDRESS 125
DISHWASHER TEL. NO.
CLOTHES WASHER
jj `+ .
LICENSE NO: LICCLASS CLASS
SWIMMING POOL RECEPTOR
TRICT NO. tWNA8UTE GROUP ZONE PROCESSED BY
LAWN SPRINKLER SYSTEM
WATER HEATER RIAL
APPROVAL
GAS SYSTEM OUTLETS INSPECTION RECORD
OUTLETS OVER
5 PER SYSTEM
I
Plan check fee
PLUMBING PERMIT ISSUING FEE S
TOTAL FEE
A?PROVALS DATE
Plan Check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
City Tel. NO.
GAS VENT
HOT WATER HEATER
HEREBY ACKNOWLEDGE THAT ( HAVE READ THLB
v- STATE THAT THE ABOVE IS ODRREYT AND AGUE TO"COATPLi'-
WITH ALL COUNTY ORDINANCES -AND STATE LAWS RECULWY!iTe
PLUMBING.
REBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICANGELES COUNTY AND'STATEOF`" ENSED AS REOU I RED BY LOS
CAL(FO RNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO
RESIDE IN THE ABOVE DESCRIBED REVOENTIAL PROPERTY. -
51GNATURE
OF PEAMITT
PLUMBING FIXTURESPLUMBING
GA$ TEST
UTILITY CO. NOTIFIED
FINAL
PERMIT VALIDATION
dao SIO
@J -
c!,M,) cash
PLAN CHECK VALIDATION:.... cli..........w D- .......C4SX
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