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APPLICATION POR PL BING PERMIT
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COUNTY OF LOS ANGELES q
1BUILDING AND SAFETY
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FCR APPE'CANT TO FILL IN (PRINT OR TYPE
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BUILDIN
ADDRESS`::
NUMBE2
FIXTURE OR ITEM
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FEE
LOCALIT %
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WATER CLOSET
NEARES
HATH TUB
CROSS SP""
SHOWER
'OWNER
LAVATORY
MAIL
ADDRE °
SINK
CITY TEL, NO
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DISHWASHERCONTRA(C
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C_O-HES WASHER
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ADDREss " . (
S'NIMMING POOL RECE'TOR
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CITY + � �TEL NLAWN
SPRINKLER SYSTEM
TATES ! - LIC.
D `CLASS
WATER HEATER
ICENSE
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GAS SYSTEM OUTLETS
A PI24VALS DATE wSPECTOR•S SicNATuRE
UNDER SCAB bVORK
OUTLETS O`✓ER
5_2.i"? SYSTEM
ROUGH I'LOM$ING
6.
GAS PIPING
a.
GAS v '?
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HOT WAjE.;R HEATER
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PLUMBM!`FI XTURES
$ $
GAS TE -.,fir
77
7
Pl fir, check fee
urulrY`o'. rOnFIFn
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PLUMBING PERMIT ISSUING FEE
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TOTAL FEE
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FINALa
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PLA! CHECK VALIDATION
Plan check appikant
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Name
f'
Address:'
,
City Tel. Na.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
-
THA -THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE :..AWS REGULATING PLUMBING. -,
PERMIT VALIDATION
HEREBY CERTIFY 1-H IAM PROPERLY ft ISTERED AND/OR LICENSED AS
REQJIRED BY LOS ANGEL COl NT A STATE F CALIFORNIA OR THAT I AM THE
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LEGAL OWNER OF, AND TEND '0 ESI E IN TH ABOVE pESC RIBED RESIDENTIAL
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Y a'* a v' +�
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i' PROPERTY.
SIGNATURE
O F- P I=. K M ITTEE'
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R",e^ '* J; it'..i 7..
DISTRICT NO.
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PR E5 D BY40
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INDUSTRIAL
WASI LAPPROVAL