HomeMy WebLinkAbout6293A (18)76A667A (CE-817A)-4/72
APPLICATION FOR "PLL PE'MIT+�
COUNTY OF LOS-ANGELES 33�t DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
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BUILDING •7���e f' 1�..����4
ADDRESSG_/
LOCALITY DI k—/ 0;nC"' L vx
FOR APPLICANT TO FILL IN (PRINT
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NEAREST /J
CROSS ST. , ,f a✓✓ ✓
NUMBER
I FIXTURE OR ITEM
FEE
.
OWNER /Y� •{ / A -&-
WATER CLOSET
BATH TUB
ADDRESS ,� 'z -Ga 4 c/o
SHOWER
CITY ,�� TEL. NO.
LAVATORY
CONTRACTOR /✓7 lL., ��% /�y�,iSC�
SINK
ADDRESS �lL.- f',✓ yJ�
DISHWASHER
TEL. NO.
CITY ���jj
CLOTHES WASHER
STATE
®U L{ CLASS
LICENSE NO: CLASS
SWIMMING POOL RECEPTOR
DISTRICT NO.
GROUP
ZONE
PROCESSED 8Y
LAWN SPRINKLER SYSTEM
WATER HEATER
INDUSTRIAL
WASTE APPROVAL
GAS SYSTEM OUTLETS
INSPECTION RECORD
OUTLETS OVER
5 PER SYSTEM
I
Plan check fee
-
PLUMBING PERMIT ISSUING FEE S
6D'
—
-
TOTAL FEE
)Z
l
A?PROVALS DATE
Plan Check applicant
UNDER SLAB WORK
Name
ROUGH PLUMBING
Address
GAS PIPING
City Tel.. NO.
GAS VENT
HOT WATER HEATER.
X EREBY ACKNOWLEDGE THAT I"HAVE READ THrs'APP LIT"TI6N"
AND STATE THAT THE A9OVE"I$ CoN'R ECT AND AGVET"Td C.p ATPLV
WITH ALL COUNTY ORDINANCES -AND STATE LAWS REIAILWYIN't"
PLUMBING.
HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LI CEN$ED AS REOU IRED By LOS 0.NGE L ES -COUNTY AND 'STATE"01
CAL( FORHIA OR THAT AM' THE LEGAL OWNEROF,END INTEND TO
RESIDE IN THE ABOVE DESCRIBED REVIIENTI.AL PROPERTY.
51GNATURE�it
OF PEAMITT�@J-
PLUMBING FIXTURES
GAS TEST
UTILITY CO. NOTIFIED
FINAL
PERMIT VALIDATION cK�,M,�t CASH
PLAN CHECK VALIDATION.'..,. CN..,.....N .i_.....,cnsi
COUfn. EN
CH
Y