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' APPLICATION FOR PLUMBING PERMIT
, COUNTY OF LOS ANGELES BUILDING AND SAFETY
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�� FOR APPLICANT i0 FILL IN IPRINT OR TYGE� BUIIDING /a f'�, �
i AODRE55 EJ
NUMBER FIXTUREORITEM � FEE
\^/ATERCLOSET �,,,` �OCALITY
j ���� NEAREST '
BATH TL1B CROSS 5T.
SHOWER OWNER
LAVATORV � MAII
ADDRESS /
SINK �� CITY TEL.N .������
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CLOTHES WASHER � ADDRE55 / 3� �
i�. $WIMMINGPOOIRECEVTOR CITY TEL.NO.0
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STATE IIC.
� � WATERHEATER � LICENSENO. � � CLA55
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OUTLETSOVER UNDERSLABN'ORK i
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�IIRNDSTATEUWSPEGULATINGVLUM8ING. PERMITVALIDATION •
, I NEHEBY CERTIFY THAT�AM PROFEP�Y AEGISTEPED ANO/ON IICENSE�AS �,'� f � �J
'� FEOVIPED BY LDS ANCELFS COVNTY P\0 STAiE OF CALIFOPYI0.OR THAT I AM THE � ' � r�n n
4 IEGAL OWNER OF,ANO IHTEND TO PESIDE IN THE ABOVE DESCPiBEO PESiOENTIRL � �'' ���l:l%
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