HomeMy WebLinkAbout1747A (10) � _ _ : ...------.. .........: .. _ ,
� r�
, 76A667A � II
CE 817�REV.I1/78) . � LS
- APPL[CATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES UILDI G AND 5 FE1Y
o- �3/�
'. FORAPPIICAN7TOFI���NfPRINTOttTYPEi qDDRE55 / FJV -
� NUMBER FI%TUREORITEl.1 8 FE �
LOCALITY ��
� WATERCLOSET- �
NEAREST
BAiHTUB /'jJ CROSSS7
I� SHOWER O�vNER
I
LAVATORY MAIL c� �� /
�'"1� ADDRES C G�V
S�NK v c. CITY ��¢��- � TE.N . ��1�
I� Dt5HWA5HER . v (/ CONTRACTOR
i
I CIOTHE$WASHER � ADDRE55 3� � �1r .
SW�MMINGPOOLFECEPTOR ' �
C�TV TEL NO. ��.���CY
LAWN SPRINKIER SYSTEM STATE LIC.
� �"lATERHEATER �-�f LICENSENO. CLA55 �
GASSYS7EM SOt1TLET5 APPFOVALS DATE m R'SSiGNATUR�
OUTlET50VER UNDERSLABWOFK ,�
5 PER SYSTEM ROUGH PlUM61NG d
iGAS PIPING V
GAS vENT �
� HOT VJATER HEATER - � Q
PLUM6ING FI%TURES `
S
GAS iEST N
� Plon check fee unutrco.NOTiFieo a
PLUMBING PERMIT ISSUING FEE E �
TOTAL FEE FINAI, ' '
Plon check opplltont . PIAN CNECK VALIDATION .
Name �
Address
��� City Tel.No.
�HEPE9Y ACNNOWLF�GE THAT I M�VE FEAD 1NI5 APFLICATION AN�STFTE , =�1 �1', j�� _
��, TMAiTNEABOVEISCOXXECTANDAGPEETOCOMPLYWITH�LLCOVNTYOA0INANCES �
•M1pSTATELAWSMEGVUIINGPLUM8ING. PERMITVA�I�ATION t�'�O'C 4 � c ��
I I NEPE9Y CERiIfY THAT I AM CPOFE(iLY NEGISTEREO A4�/Ofl LICENSED AS � �
REOViFEV Bv LOS ANGELES COUNiY�NO STATE OF CALiFORniA OR THAT I AM TME �'r•e 4 �(�,����
LEGAL OWNEP Of,AND INTENO TO RESIDE IN THE ABOVE DESCRIBEO RESIOENTIPL
PAO�EPTY. � �
II��. SIGNATUFE � � . �.� -
�, �.�
OF PERMITTEE � ` �,�,'� �•.C'_�n c
DISTRICT NO. Pf�OCE55ED BV �
� ��
�I INDUSTRIAL - '
I WASTEAPPROVAL
�' •
l
_ _. _.__ . _-
1