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°'APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
FORAPPLICANTTO FILL IN(PRINT OR TYPE, BUILDING
NUMBER _FIXTUREORITEM ® FEE
ADDRESSI
WATER CLOSET LOCALITY ..J1 n t1-JBATHTUB NEAREST
CROSS ST.
SHOWER OWNERLAVATORY. MAIL
ADDRESSSINKCITY
DISHWASHER CONTRACTOR(.
CLOTHES WASHER ADDRESS O �Scl ,1' 4i 0 U !E'-
SWIMMING POOL RECEPTOR 11
CITY U__�'_7+'- TEL.NO.
LAWN SPRINKLER SYSTEM _
STATE -� _
i' WATER HE LICENSE NO. •] CLASS
GAS SYSTEM OUTLETS DISTRICT NO. r.GROUP" ZONE PROCESSED BY
OUTLETS OVER
�.; 5PERSYSTEM INDUSTRIAL O
WASTE APPROVAL V
INSPECTION RECORD W
` UJI
LL
Plan check fee IL
$
e
PLUMBING PERMIT ISSUING FEE$
TOTALFEE 777
li✓ Pldn check opplicaDt
�F Name APPROVALS DATE INSPECTOR'S SIGNATURE
I. UNDER SLAB WORK
Address - ROUGH PLUMBING
I' City 1 Tel.No. GAS PIPING
�. I YEREBY ACKNOWLEDGETHAT I HAVE READ THIS APPLICATION AND STATE GAS VENT
'{ THAT THE ABOVE IS CORRECT AN DAGREE TO COMPLY WITH ALL COUNTY ORDINANCES
E AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER
I 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FI%TURES
I REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM TXE GAS TEST
I LEGAL OWNER OF.AND INTEND TO BESIDE IN THE ABOVE DESCRIBED RESIDENTIAL
PROPERTY.. �� , UTILITY CO.NOTIFIED
SIGNATURE 1� `J
I OFPERJVIIT iE FINAL
PLAN CHECK VALIDATION CN. M.D. CASH PERMIT VALIDATION CK. ...0. CASH
y..