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APPLICATION FOR PLUMBING PERMIT
II
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.
I SHOWER OWNER //v /<,�ilJ/1G •C_
MAIL L:I
T LAVATORY ADDRr/ESS�S /''/•�
SINK CITY.'V4':`/f(%��/,/C-,"/r` ~TEL.NO. .1,�^.1�..j
DISHWASHER CONTRACTOR" (Y
CLOTHES WASHER
ADDRESS:` -�, /'✓- Te,7
SWIMMING POOL RECEPTOR 1�
I CITY �'J�J' %-•V:-� TEL NO.
LAWN SPRINKLER SYSTEM
-STATE f�'.%_/GI�--- LIC.
WATERHEATER LICENSE NO.%,'� CLASS
�. GAS SYSTEM OUTLETS DISTRICTNO ,ROUP " PROCESSED BY
OUTLETS OVER
SPER SYSTEM INDUSTRIAL - U
WASTE APPROVAL
!k!k INSPECTION RECORD
10-1
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Plan check fee
i PLUMBING PERMIT ISSUING FEE E •� � ��' F�-
I: TOTAL FEE
Plan check applicant
Name APPROVALS DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
��. Address-- - ROUGH PLUMBING
II' 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
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 THE GAS TEST
1 LEGAL OWNER OF.AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDE NTML
PROPERTY. ^ UTILITY CO.NOTIFIED
SIGNATIIRC /�� %C�:i
OF PERMITTEE / ± •-� ^ �'- FINAL
1
PLAN CHECK VALIDATION tK.' M.o. CASH PERMIT VALIDATION CK. - M.O. CASH
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