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APPLICATION FOR PLUMBING PERMIT
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COUNTY.OF LOS ANGELES "
DEPARTMENTOF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN IPRINT OR TYPE, BUILDING /
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NUMBER FIXTURE 02 ITEM ® fEE ADDRESS J
t WATER CIOSET LOCALITY
BATHTUB NEAREST - -
CROSS ST.
SHOWER OWNER //v /<"�i/..�(,J I1G •C_
T LAVATORY MAIL ADDRESS �''/`�
SINK CITY.'VC':`/f(%��/:/C''-I/` ~TEL.NO.'/'
DISHWASHERCONTRACTORi %.�� /�_%%��L-,l '/ -'[JJ�_'
CLOTHES WASHER
ADDRE55/:i_'� /-✓- I•t'J
?7777-
SWIMMING POOL RECEPTOR
I CITY !'J�j�: .1/:.� TEL NO.
LAWN SPRINKLER SYSTEM
STATE �1� LIC.
WATERHEATER LICENSE NO." CLASS
CLASS
�. GAS SYSTEM OUTLETS DISTRICTNO; P,ROUP ZONE PROCESSED BY
OUTLETS OVER
SPER SYSTEM INDUSTRIAL U
WASTE APPROVAL
_ INSPECTION RECORD w
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Plan check fee
i PLUMBING PERMIT ISSUING FEE E •� � ��' F�-
I: TOTAL FEE
Plan check applicant
Name APPROVALS DATE INSPECTOR'SSIGNATURE
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 THE ABOVE 15 CORRECT ANO AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
L AND STATE LAWS REGULATING PLUMBING. _ HOT WATER HEATER
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I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES
j REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM TME GAS TEST
T LEGAL OWNER OF.AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL
PROPERTY. ^ UTILITYCO.NOTIFIED
$IG NATU, C .i
OF PERMITTEE / �± v / -".l �'- FINAL
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PLAN CHECK VALIDATION cK.' M.o. CASH PERMIT VALIDATION CK. - M.O. CASH
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