HomeMy WebLinkAbout0 (19) 76AS67C lees 17-Al-11/76 p
APPLICATION FOR PLUMBING PERMIT
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- - COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER -
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN(PRINT ORTYPEI BUILDING
EEE NUMBER FIXTUREOR ITEM ® FEE ADDRESS t
C V/ATERCLOSET LOCALITY:,.
4y NEAREST
BATHTUB CROSSST. i 1
SHOWER OWNER �Sl,�^_t!:d:'Y-'t•'L'`J--�-�-
LAVATORY MAIL
ADDRESS
'P SINK CITY -l+t,;"J I V-+1/ -✓= EL.NO.
DISHWASHER CONTRACTOR 1,G!f- Iy'\v✓�=` ��1�_`rt
CLOTHES WASHER ADDRESS U I') r,J• y V 4 M'`• / !
SWIMMING POOL RECEPTORCITY ,i ,�. 'CJ{'�[% TEL NO.
LAWN SPRINKLER SYSTEM _
STATE � LIC. J ..
WATER HEATER LICENSE NO. l� + CLASS
GAS SYSTEM OUTLETS DISTRICT O.- �+ROIM 20NE PROCESSED BY
06
OUTLETSOVER Q
S P R SYSTEM INDUSTRIAL 0
(l-'AI's".� _ i / WASTE APPROVAL -
UA
INSPECTION RECORD
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Plan check fee
PLUMBING PERMIT ISSUING FEE$ �/ r
TOTALFEE r.
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APPROVALS DATE INSPECTOR'S SIGNATURE
Name -
UNDER SLAB WORK
Address ROUGH PLUMBING
City Tel.No. GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT
THAT THEABDVEISCORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES HOT WATER HEATER
AND STATE LAWS REGULATING PLUMBING.
I I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES
REQUIRED BY LOS ANGELES COUNTY AND STATE OE CALIFORNIA OR THAT I AM THE GAS TEST
LEGAL OWNER OF.AND INTgND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL
;PROPERTY. r V.LATy
IICO.NOTIFIED
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SIGNATURE I,� //-'� v},I
�tI OF PERMITTEE ` Z L
- PLAN CHECK VALIDATION cK. M.O. cnsH PERMIT VALIDATION CK. M.O. CASH
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