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��. CE B17(REV.11/7B) �� . �
I; APPLICATION FOR PLUMBING PERMIT
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� COUNIY OF LOS ANGELES UILDING AND SAFETY
I�' FORAPPLIC4NTTOFIIIINIPRINTORTYPEI BUILDING �Q' � 3 /a .
I ADDRE55�j�Q – �
t NUMBER FIXTUREORITEM ' � FEE
� WATERCLOSET � ,�,` �OCALITY ' /
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SHOWER OWNER
i LAVATORY MAII r �
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i DISHWASHER � CONTRACTOR �
ICLOTHES WASHER ADDRE55�33� '
j SWIMMINGGOOLRECEPTOR ��— /
CITY TEL.NO.
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I WATER HEATER �� LICENSE NO. � (p C ASS C/"
� GAS SVSTEM OUTlETS �� APPROVALS OATE �r� e[T caemat
UN�ERSLAB\";ORK �
I OUTLEiSOVER �
�� 5 PER SVSiEM POUGH 7WMBING � �'
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k PLUMBING FI%TURES �
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PLUMBING PERMIT ISSUING FEE S �
TOTAL FEE FINAL
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C Name
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I� I HEPEBv�ChNOWlEOGE TXAT I MAVE READ TXIS 11PPLIC�TION AND SiATE ' _�� ��,/_:��.,
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1 MEREBY CENi1FY THAT 1 AM PROPEFLY REGISTERED ANO/OP LICENSED AS �� • � � ��
FEOUIPE�9Y LOS ANGELES COUNTY A.YD STATE OF CRUGOPNIA OR TN0.T I�M iHE b'n[�� /,
LEGRL OWMEH OF,AND INTENO TO PESIDE IN TME ABOVE OESCRIBEO PESIDENTIAI I ,��v
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