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APPLICATION FOR PLUMBING PERMIT
"'. .. COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING/. ' j,✓7 ��/,
NUMBER - FIXTURE ORITEM ! FEE
ADDRESS L .'i — /Y•�: /` C.
WATER CLOSET LOCALITY ;/'/ /.//I�i✓,� �f;
NEAREST
BATH TUB CROSS SL
u�g SHOWER OWNER
LAVATORY MAIL
ADDRESS'�fi/✓�1
SINKCITY fJ�''•/P�/ : /'EL.NO.
I' DISHWASHER CONTRACTOR r.%�( /r-�T�f.f1 .r"){.� I✓4
CLOTHES WASHER l :
�.- ADDRESS �--'�_.�-� L�
SWIMMING POOL RECEPTOR
- CITY %if L'„�,f TEL.NO. �y�•.[�4,
LAWN SPRINKLER SYSTEM
STATE 1 �1,..., LIC. /—
I. WATER HEATER- LICENSE NO. / l`fl! .: CLASS 'J
GASSYSTEM OUTLETS
DISTRICT NO. /GROUP., ZONE :PROCESSED BY
OUTLETS OVER 0:
5PER SYSTEM _ INDUSTRIAL _ Y
! r WASTE APPROVALINSPECTION RECORDr0Plan check fee �PLUMBING PERMIT ISSUING FEE$ C. LuTAL FEEPlan check opplicowName APPROVALS DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
Address' ROUGH PLUMBING
City Tel.No. GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLO STATE GASVENT
THAT TME ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL CNANCESAND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ASED AS PLUMBING FIXTURES
PEOUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNAM THE GA$TEST
LEG0.L OWNER OF.AND INTEND TO RESIDE IN THE ABOVE DESDENTIAL
PROPERTY. /fj UIILITYCO.NOTIFIED
i. SIGNATVRE
II OF PE RM ITTEE
i
PLAN CHECK VALIDATION cK. M.o. CASH PERMIT VALIDATION CK. M.o. CASH -
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