HomeMy WebLinkAbout1697A � . _. . ._....__-----,.., _...: . , . _ .._ _ . ... . . .... . ..:I - �
' 76A667A ' . .� �
�. CE Bq(REV.11/7BJ '� ts
I
� APPLICATION FOR PLUMBING PERMIT ',
, COUNTY OF LOS ANGELES _ i BU�DING AND SAF 33 � �
�_�f� b '
FORAPPLICANTTOfILLINIPRINTORTYPE� BUIl01NG / /
ADD2E55 ��l�1�
NU1��BER FI%1URE OR ITEM1S 6 FE ��
I�I WATERCLOSET �� LOCALIiY �,
NEAREST
��� BATHTUB � CROSSST
SHOWER � OWNER
LAVATORY - � MAIL �(� �
ADDRESS � 6t/L�
SINK ' � � CITY TEL.N ' �.�r���
DISHWASHER � � CONiRAC10R
CIOiHES\VASHER �v qDDRES5�,33,sa �
SWIMMiNG POOL RECEPiOR
OT TEL.NO. ��—�p�
�'� LAWNSPRINKLERSYSTEM StATE /J ��� -
WATERHEATER � LICENSENO. ' J b CLA �
GASSVSTEM �OUTLETS _ /Z} AP7ROVALS DA7E sr TOP'SS�GM uec
I� OUTLETSOVER UNDERSLABWORK
5 PER SYSTEM ROUGH PLUMBING '� I 6
� � GASPIPING '� O
V
� GAS VENi � �' p{
HOTWATERMEATER � �
PIUMBING FIXIURES �
GAS 7E5T N
Pian check fee uTairrco NOTiFieo � �
�, PWMBING PERMIT ISSUING FEE b �
TOTAI FEE � FINAI ' / '
I� Plon check applicant . PLAN CHECK VALIDAT N i �
� Name
I
�� Address � ',
� City Tel.No. � I,
� I HEPEBY ACNNOWLEDGE iHRT I M�VE READ THIS AGPLIC�TION PNO ST�TE , _"'� ��'n��r,
TNAT TME ABOVE IS CORRECT 11N0 RGNEE TO COMPLY W ITH 0.LL GOUNTY OROINRMCES i
•HDSTATElAWSNEGIILATINGVLUMBING. PERMITVALIDATION I I u �-
I NEREBY CE1iTtFY THAT I AM IPOPEPLY REGISTEAEO PND/OP IICENSEp AS ' , � tI�
PEOUIREO BY LOS RAGELES COUNTY AND STATE OF CP4FOPNIA OR TMAT I AM THE �
LEGlL OW�ER Oi.PKO INTENO TO REStDE IN TNE PBOVE DESCPIBEO HESIDENTIAL - '�O � �''����'� ,�
PHOPEHTY.
ISIGNATURE � I � ',
OFPERMITTE 'I � ,1 ,—
DISTRI�T NO. �8Y � �I
' a
r I
� INDUST2IAl � . I,,.
�I WASTE APPROVAI i
L I
�:�
�;
, .
6
t.
`