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APPLICATION FOR PLUMBING PERMIT .
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BUILDING AND SAFETY DIVISION ' 46c)cj
FOR APPLICANT TO FILL IN(PRINT OR TY PEI BUILDING
I NUMBER FIXTURE OR ITEM C. FEE ADDRESS
WATER CLOSET LOCALITY
BATH TUB NEAREST
tqt CROSS ST,
IF SHOWER OWNER "r•,
[ LAVATORY MAIL '
SSS ADDRESS
�'. SINK CITY TEL.NO.
DISHWASHER CONTRACTOR .y... I•."li r
' CLOTHES WASHER
j ADDRESS .-;I,.. 1
SWIMMING POOL RECEPTOR , v r"
C ITYYi I ..:, .j e TEL.NO.
LAWN SPRINKLER SYSTEM '
STATE .� LIC
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WATER HEATER LICENSE NO. L:n' L' CLASS ✓
DISTRICT NO. GROUP ZONE PROCESSED BY W
F GAS SYSTEM OUTLETS I I J
I' OUTLETS OVER ,
5 PER.SYSTEM (Ufigg
WZ$TE APPFOVAL o
INSPECTION RECORD w
i Plan check fee
PLUMBING PERMIT ISSUING FEE $ f I•
r'
TOTAL FEE
Plan check applicdnt -
t. .Name .. APPROVALS DATE FEcaoP•s aieH.TUNE
UNDER SLAB WORK
l'Address
ROUGH PLUMBING
(:'City Tel.NO. GAS PIPING
I HERESY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT
iO STATE TN AT THE ABOVE IS CORRECT AND AGREE TO COMPLY
'TH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
VMSING.
'I HERESY CERTIFY THAT I AM PROPERLY REGISTERED ANOYOR PLUMBING FIXTURE$
'ENSE0 AS AEOUIIIED SY LOS ANGELES COUNTY AND STATE OF GAS TEST
I FORNIA DR THAT 1.,AM THE LEGAL OWNER F,AN4—TENO TO
0E IN THE ASDYE DESCRIBED R"t TIAL P PEIf�1Y.f UTILITY CO.NOTIFIED
PE RdA1TTE 'FINAL
CHE (DATION CK. M.O. CASH PERMIT VALIDATION EK.. M.D. CASH
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