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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
- 3 31c-
FOR APPLICANT TO FILL IN (PRINT OR
TYPE)
BUILDING
ADDRESS
NUMBER
FIXTURE OR ITEM
®
FEE
LOCALITY
WATER CLOSET
BATH TUB
NEAREST
CRO55 ST.
SHOWER
OWNER
LAVATORY
O LJ
MAIL
ADDRESS
SINK
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O V
CITY TE?DISHWASHER
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�UCONTRACTORCLOTHES
WASHER
O1gDDRE55SWIh1MING
POOL RECEPTOR
CIT TEL.LAWN
SPRINKLER SYSTEMSTATE
LIC.WATER
LICENSE NO. S2� CLAGAS
HEATER
SYSTEM r OUTLETS
APPROVALSDATE
GAS PIPING
GAS VENT
HOT WATER HEATER PLUMBING FIXTURES
GAS TEST
Plan check fee
I
UTILITY CO. NOTIFi
PLUMBING PERMIT ISSUING FEE S
TOTAL FEE
FINAL
Plan check applicant
PLAN CHECK
Name
Address
City Tel. No.
I HEREBY ACI(NDWLEOGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY W ITH ALL COUNTY ORDINANCES
AW STATE -SPECULATING PLUMBING.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS
REOUIRED 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
OF PERMITTEE
DISTRICT NO.
PROCESSED BY
PERMIT VALIDATION