HomeMy WebLinkAbout0 (20) �aA�TaIaE�IAPPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES -
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
i, FOR APPLICANT TO FILL IN(PRINT OR TYPE r BUILDING ( r ( .�L.
NUMBER FIXTURE OR ITEM O FEE ADDRESS /
WATER CLOSET LOCALITY
AREST
BATHTUB' NE
CROSS$T.
�. SHOWER OWNER
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I, LAVATORY - ADDRESS !�•�: iJ✓f G.f� /. ..i�/`%i..i �J
�. SINK CITY'V�. L,/f'.;i� ! �:r/ TEL.NO. f
DISHWASHER CONTRACTOR
l CLOTHES WASHER
( ADDRESS� �v'J.�/ !jY✓„ 'I.
SWIMMING POOL RECEPTOR CITY ��� -i j1_:-��J TEL.NO.fV'—Y:•'l.
' LAWN SPRINKLER SYSTEM y
STATE ?r'),,�-- LIC.
WATER HEATER LICENSE NO. �'',? y�- - CLASS T
GAS SYSTEM OUTLETS DISTRICT NO., _ ;CROUP. ZONE .PROCESSED BY
Y
OS PER SY EMR 6
- INDUSTRIAL
WASTE APPROVAL V
INSPECTION RECORD us
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Plan check fee
PLUMBING PERMIT ISSUING FEE$ i m
r
TOTAL FEE I `
Plan check applicant
Nome APPROVALS DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
Address ROUGH PLUMBING
City - Tel.No. GAS PIPING -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT
THATTHE ABOVE IS CORRECTAND AGREE TO COMPLY WITH ALL COUNTY OHDINANCES
AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES
l REOUIRED BY L05 ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE GAS TEST
L LEGAL OWNER OF,AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL
L PROPERTY. jam+/�, UTILITY CO.NOTIFIED
SIGNATURE
I OF PERMITTEE FINAL
PLAN CHECK VALIDATION a. �.,o.� CASH PERMIT VALIDATION CK. M.a. CASH
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