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� 76A667A : 11 .
. GE 817(REV.11/79) � , rs
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
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� - 33 �
i FORAPPUCANTTOfILIINIPRINTORTYFEI BUILDING �.
�: AODRE55
NUMBER FIXTUREORITEh1 � FEE
IOCALITY
� WATERCLOSET �
NEAREST
BATHTUB � CROSSST
4 SHOWER � OWNER .�
IAVATORY MAII ,fi� .
O� ADDRESS��0 � �7
� SINK � CITY � TEI.N . � y
f �ISHWASHER � C�U CONTRACiOR
CLOTHES WASHER �� ADDRESS 3�� ;
` SWIMMING POOI RECEPTOR
1 � LAWN 57RINKLER SYSTEM CITY � IEL.NO. �j.—��p
STATE I�J C-6d CLASS
I WATERHEATER 3 � LICENSENO.( ( J 0
I� GASSYSTEM �OUTLETS � APPROVAL$ D TE �
4 OUTLETSOVER UNDERSLAB�M1'ORK � � /
5 PER SYSiEM ROUGH P W AABi NG ��
� GAS PIPING V
GAS VEN7 p�
HOT WATER HEATER • �
PLUIdBING FIXTURES i�
1L
GASTESi ' � N
I' Plan check fee unurrco.NoriFieo 1 �
PLUMBING PERMIT ISSUING FEE$ � �
TOTAL FEE � FINAL (s'
I� Plan check applicont - PLAN CHECK VALIDATION
( Name
1'
� Address
i Ciiy Tel.No. . .��I 7�._��',
I NEPEBV RCNAOWLEDGE TNAT I NAVE PEI�D TNIS�FVLICAtION AND ST�TE - � ' ' r
TMATTHE�BOYEISCOflRECTANDAGRFETOCOMPLYWIiHRLLCOVNTYOF01A4\CES ��;�" � � � ..
AND S7ATE LAWS XEGIILATING PLUMBING. PERMIT VALIDATION ' /�/�'
I NEREBv CEXTIfY TNAT I AM PpOGEPLY REGISTERED ANO/OR�ICENSE�AS , I�°�^l��v v
PEOVIPED BY LOS RNGELES COUNTY RND STATE OF CPLIFORNIA OP THAT�AM TME .
LEGAL OWNEH OF,pND IHtEND t0 PESIOE IN TME ABDYE DESCPIBED PESiOEYTtAL �, ,. , `4;1���=
PROPERTY. � r m i,
S�GNATVRE //9 � f �•�,�— � �
I` OF PERMITTEE! `�" , ' �
DISTRICT NO. RO ESSED BV
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� IN�USTRIAL .
�' WASTE APPROVAL ��
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