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APPLICATION FOR PLUMBING PERMIT
' COUNTY OF LOS ANGELES BUILDING AND SAfEfY
• - 33/a
FOR APPLICANT TO FILL IN IPRINT OR TYPEI BU�IDING3l3�
AD�RE55
NUMBER FIXTUkEORITEM 6 FEE
4 WATERCLOSH �.,1 ���LITY
U " NEAREST
� BATH TUB � CRO$$ST.
SHOWER � OWNER ��
f ,(� MAII s�f�-.! / _i7'j i
� LAVATORY v(/ ADORESS O (�(�( Pr v
ISINK CITY� TE.N . ��/ 1
� DISHWASHER CONTRACiOR �
CLOTHE$WASHER !�J ADORE55 33� .
I SWIMMINGPOOIRECEPTOR �
I CITY TEL NO. ��.—tLfCj/
LAWN SPRINKLER SVSTEM STATE / IIC.
i
WATERHEA7ER � �ICENSENO. ( CLA —�
� GASSYSTEM �OUSIESS � APPRQVAlS �ATE N CTOP'SSIGN�T
OUTlET50VER UN7ERSlABWORK �
� 5 PER SYSiEM � ROl1GH PWMBING L
k ' GA$PIPING � U
I
j GASVENT p�
HOT VlATER HEATER o
' PWMBINGFI%iURES � Z
GAS TEST N
' Plan check fee unuTrco.NonFieo �
PLUMBING PERMIT ISSUING fEE$ � �
�� TOTALFEE FlNAL
Plan check applicanr
PLAN CHECK V ll ATION °
Nome
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F Address
I City Tel.No. � �1 7 �f:
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I NERE9Y ACNNOWLEOGE TNAi I H�VE REAO THIS APPLICATION AYO STATE '
TXATTNEABpVEISCOFPECTANORGREETOCOMOLYWITHALLC0UN1Y0RDINANCES $�,p�p „ o ��
AAO ST�TE lPWS HEGIIIAiING iLUMBIHG. PERMIT VALIDATION . �
� I NEPEBY CENT�FV TNAT I AM PPOVERLY REGISTEREO�NO/OR IICFH5E0 AS � �1{p'��C C�r
� FEOUIFFp BY LOS�NGELES COUNiY ANO SiFTE Of CRLIFOPNI0.OP TNRi 1 AM THE � � �
LELRL OWNER OF,qN0 iNTEND t0 PESiOE IH TNE PBOVE OESCPiBE�RESiOENTIAI � ( ^
PPOPEFTY. ' �' °�'. :. ..l:`)C-
SIGNATVRE � ' �I �.�/�'�I��
OFPERMITTEE -
DIS^TR�ICiNO. �— PII 'ESSEDBY � , �
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i INDUSTRIA� • .
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