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CE 817(REV.I1/7B)
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES • UILDING AND SAFETY
o - �33 0
FOR APPLICANT TO FILL IN IPRINT OR TYPEI BUILDING ` L'{, / _ � /
� ADDRESS r�,[�i (��'
NUMBER fIXTURE OR ITEM 8 FEE �
WATER CLOSET � �OCALITY '
NEAREST
BATH TUB CRO55 ST.
SHOWER .S-�1 OVVNER �i�����
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LAVATORY MAIL c�
ADDRESS � [
' SINK � CITY � T �p,{�j�I
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DISHIVASHER - � CONTRACTOR �
CLOTHES WASHER � � ADDRESS 33J v
� SWIMMING POOL RECEPTOR —
CITY TEL.NO ��SL /
LAV:N SPRINKLER SYSTEM
STATE y LIC. n ? �
WATER HEATER , LICENSE NO. p CIASS t� �.YEj
GAS SYS'EM SOUTLETS � APPROVALS DA E �ti E R'S SIGNATURE
OUTLETS OVER UNDER SLAB 1M1'ORK
! S PER SYSTEM �
ROUGH PLUMBING
GAS PIPING �
1J
GAS VENT p�
HOT WATER HEATER �
PWMBING FIXiURES �
GAS TEST V1
' Plan check fee UTILITYCO.NOTIFIED z
' PLUMBING PERMIT ISSUING FEE$ �
I FINAL �
�' TOTAL FEE �
Plan chetk opplicant
PLAN CHECK VALIDAiION
i Name
� Address
City Tel.No. ._ .� ,7 .�.C) �•
I HEREBY ACKNOWLEDGE TMFT 1 HAVE REAO THIS APPLICATION AND$1ATE
� THAT TNE ABOVC IS CONRECT A!10 AGREE TO COMPLY W ITM ALL COUNTV ORDINFNCE$ ' f��o • e • s �`
� AhD STATE LAwS REGULATING PLUMBIIIG. PERMIT VALIDATION �' `'
I I HEREBY CENTIfY 7H11T I AM PROPERLY flEG15TERE0 AND/OR LICENSED AS � c 'o L� ��,�,!�l
i RE�UIRED BY LOS ANGELES COUNTY AND STATE OF CAUFOR4i0.OR THAi I�AM TME _
LEGAL OWYER OF,AND INTENO TO RESIDE IN TME ABOVE DESCRIBED RESIOENiIAL `�`_ � I, (i �l �
PROPERTY. � �� �� -
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� SIGNATURE � 1���—'I�'
I
OF PERMI7TEE
DISTRICT NO. SED BY
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i INDUSTRIAL
I 1,b'ASTE APPROVAL
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