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APPLICATION FOR PLUMBING PERMIT
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- - COUNTY OF LOS ANGELES
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DEPARTMENT OF COUNTY ENGINEER -
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN(PRINT ORTYPEI BUILDING
EEE NUMBER FIXTUREORITEM ® FEE ADDRESS t
C V/ATERCLOSET LOCALITY:,.
4y NEAREST
BATHTUB CROSSST. i 1
SHOWER OWNER
LAVATORY MAIL
ADDRESS
SINK CITY -1+1,;"J I V-+1/ ✓ EL.NO.
DISHWASHER CONTRACTOR 1,-��l- ly'\v✓��` ��1)_`rt
CLOTHES WASHER ADDRESS . U i') r,J• V v M"• / !
SWIMMING POOL RECEPTOR CITY ,i'I� . 'VI'..[y TEL.NO.
LAWN SPRINKLER SYSTEMLI
STATE C J ..
WATER HEATER LICENSE NO. ( + CLASS
GAS SYSTEM OUTLETSI
DISTRICT O.-- UP 20NE PROCESSED BY
OUTLETS OVER Q
SPR SYS06
TEM INDUSTRIAL u
?i (l A�' WASTE APPROVAL -
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INSPECTION RECORD
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Plan Check fee
PLUMBING PERMIT ISSUING FEE rTOTAL FEEPlan check applicant
APPROVALS DATE INSPECTOR'S SIGNATURE
NameUNDER SLAB WORK
Address ROUGH PLUMBING
City Tel.ND. GAS PIPING
LSTATE
EREBY ACKNOWLEDGE THAT I HAVE READ THIS AATE GAS VENT
ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALES HO1 WATfR HEATER
E LAWS REGULATING PLUMBING.REBY CERTIFY THAT I AM PROPERLY REGISTERED AS PLUMBING FIXTURES
BY LOS ANGELES COUNTY AND STATE OECALIFORNIA OR THAT I AM THE GASTEST
NER OF.AND INTq ND TO RESIDE IN THE AYOVE DESCRIBED RE 5IDE NTIAL
. r U71LITYCO.NOTIFIED
REI,� ..MITTEE ` Z FINAL
- PLAN CHECK VALIDATION CK. M.D. cAsH PERMIT VALIDATION CK. M.O: CASH
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