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APPLICATION FOR "PLL PE'MIT+�
COUNTY OF LOS-ANGELES 33�t DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
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.. .... .. .... .. ... ......<., ,.. .,..
BUILDING )j7,0 ,
ADDRESS o' (> G_/
LOCALITY �'f/7/Vt O;nC"' L
FOR APPLICANT TO FILL IN(PRINT
-DR TYPE
NEAREST /J
NUMBER
I FIXTURE OR ITEM
FEE
OWNER kv 01 •{ / ��A-&-
WATER CLOSET
BATH TUB
ADDRESS ,� z -CC 4 L! y c/o
SHOWER
CITY ,�� TEL. NO.
LAVATORY
CONTRACTOR /✓7 lC., t✓ /�y�,iSCv
SINK
ADDRESS /;V-
DISHWASHER
CITY ��TEL. NO.
CLOTHES WASHER
S AT
STATE
LICENSE NO;�f'" ®U L{ CLASS ��,�
SWIMMING POOL RECEPTOR
DISTRICT NO.
GROUP
ZONE
FROG ESSED BY
LAWN SPRINKLER SYSTEM
WATER HEATER
IN
WASTE APPROVAL
GAS SYSTEM OUTLETS
INSPECTION RECORD
OUTLETS OVER
5 PER SYSTEM
I
Plan check fee
-
PLUMBING PERMIT ISSUING FEES
ij
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
X EREBY ACKNOWLEDGE THAT I''HAVE READ THrs-APP Ll exT 1 ON`,
AND STATE THAT THE A9OVE"IS CORWRECT AND AGVET"Td COATPLi'-�
WITH ALL COUNTY ORDINANCES' -A:ND STATE LAWS REGU'LWY!iTe'
PLUMBING.
HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
ENSED AS REOU I RED BY LOS LICANGELES COUNTY AND STATE OF'
CAL(FO RNIA OR THAT AM THE LEGAL OWHEfl OF, AND INTEND TO
RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL P RO PERTY.'
51GNATURE�iC
OF PEAMITT�@J-
PLUMBING FIXTURES
GAS TEST
UTILITY CO. NOTIFIED
FINAI-
Sslao _A'In
PERMIT VALIDATION c!�,�,M,�t CASH
PLAN CHECK VALIDATION:'..,. CN..........w D_ 11 ....cnsi
COUfn. ETI
CH