HomeMy WebLinkAbout0 (23) �eA�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
NUMBER FIXTURE OR ITEM O FEE ADDRESS
' WATER CLOSET LOCALITY
BATHTUB' NEAREST
CROSS ST.
SHOWEROWNER
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I, LAVATORY - MA
ADDRESS J�•�' iJ✓f G.f� /. '..i�/`%i..i �J
f .SINK- - CITY'Y. ;-Iij'! TEL.NO.'-
DISHWASHER
O.-DISHWASHER CONTRACTOR
f CLOTHES WASHER
( ADDRESS�v'J.�� !jY✓„ 1,
SWIMMING POOL RECEPTOR
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' LAWN SPRINKLER SYSTEM CITY
STATE1 /),,�-- LIC
WATER HEATER LICENSE NO. �! CLASS
GAS SYSTEM OUTLETS DISTRICT NO. _ ;GROUP, 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
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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
THAT THE ABOVE IS CORRECTAND AGREE TO COMPLY WITH ALL COUNTY Ofl01NANCES
AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES
l REQUIRED BY L05 ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM TME GAS TEST
L LEGAL OWNER OF,AND INTEND TO RESIDE IN THE ABOVE DESCW.ED RESIDENTIAL
L ;PROPERTY, UTILITY CO.NOTIFIED -
SIGNATURE
I OF PE RM ITTEE FINAL
PLAN CHECK VALIDATION - a. �.,o.� CASH PERMIT VALIDATION CK. M.a. CASH
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