HomeMy WebLinkAbout0 �. 76AG67C ICA 617;AI•11/70-
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
NUMBER - FIXTURE OR ITEM ! FEE
ADDRESS L .'i — /Y•�: /` C.
WATER CLOSET LOCALITY ;/�'//,/.i/I�i✓,� �f
NEAREST
BATH TUB CROSS SL
u�g SHOWER OWNER
LAVATORY AMAIL
DDRESS���`/i1
SINK CITY %4J�.• /P�//-{�: /'EL.NO.
DISHWASHER CONTRACTOR
CLOTHES WASHER
�,- ADDRESS
SWIMMING POOL RECEPTOR
- CITY %if L'„,f TEL.NO. /Y�•.[ 4�
LAWN SPRINKLER SYSTEM
STATE
_-ll` LIC.
4. WATER.HEATER- - LICENSE NO. /" f�" CLASS ` J
Ii GASSYSTEM OUTLETS DISTRI T NO. /GROUP., ZONE :PROCESSED 8Y
OUTLETS OVER Id
5PER SYSTEM _ INDUSTRIAL - Y
_ ! r WASTE APPROVAL
INSPECTION RECORD r
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0
Plan check fee 4. A.
j PLUMBING PERMIT ISSUING FEE$ J f. Lu
ITOTAL FEE'
Plan check applicant -
F Name APPROVALS DATE 1N5PECTOR'S SIGNATURE
f UNDER SLAB WORK
Addl ROUGH PLUMBING
City TBI.No. GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT
•THAT TME ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
ANDSTATE LAWSREGULATING PLUMBING. HOT WATER HEATER
I' I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS .PLUMBING FIXTURES
L, PEOVIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE GAS TEST
LEGAL OWNER OF.AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL
PROPERTY. UTILITYCO.NOTIFIED
i. SIGNATVRE �.GNT � .,._
II OF PE RM ITTEE_4 FINAL _
i
PLAN CHECK VALIDATION CK. M.o. cesH PERMIT VALIDATION CK. M.D. CASH -
I i - - a.., ;•:rte 'C 1 C Jif .- .
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