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� CE 817(REV.11/7B) !S
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES UILDING AND SAFETY
33/0
FOR APPLICANT TO FILL IN IPRINT OR TYPEI BUILDING /� �
ADDRESS D l.iY'�
NUMBER FIXTURE OR ITEM � FEE �
3 WATER�LOSET ,�,1 ��CALITY � ��
���� NFAREST
BAiH TUB CROSS ST
SHOWER OWNER
i �` LAVATORY ADDRESS�r�I� �/
SINK CITY TE .NO. �� ��..�
DISHWASHER �!u CONTRACTOR �
CIOTHES WASHER � ADDRE55 3� �,
SWIh\MING POOI RECEPTOR
CIT TEL.NO��a���a�
LAWN SPRINK�ER SYSTEM —�
SiATE / UC. �
WATER HEATER LICENSE NO. / � CLA55 �
GASSYSTEM OUTlETS � APPROVALS Df, E i v oa'
OUTLETS OVER UNDER SLAB WORK /< < !
5 PER SYSTEPA ROUGH PLUMBING `
GAS PIPING u
GAS V ENT pp
HOT�NATER HEATER Q
PLUMBING FIXTURES Z
� GAS TEST N
! Plan check fee UTILITYCO.NOTIFIED Z
� PLUMBING PERMIT ISSUING fEE$ �
�
TOTAL FEE � FINAL �
Plan theck opplicont PLAN CHECK VALIDATION -
Name '
� Address
i
I Ciry Tel.No. :-_ � I`, �' f
�I 1 HEPEBv A�KNOWLEDGE THAi 1 HRVE READ THIS APPLICATION AND STAiE
iMATTHEABOVEISCONRECTANDAGFEEiOCOA1P�YWITHALLCOIINTVORDINANCES � �;�O '• �P 2a < <
AND STATE LAWS REGULATING PLUMBiNG. , PERI`AIT VALIDATION
� I HEPEBV CERTIFV THA7 I AM PROPERLY REG�STERED ANO/OR LICENSED AS � • �tl �)� �'�(1
NEOUIRE�BY LOS FNGELES COUNTV ANO SiATE Of CALIFORkIA OR THAT 1 AM TNE
lEGl1L OWNEfl OF.RNO INTEND TO NESIOE IN THE ABOYE�ESCRIBED RESI�ENTIAL � .� : (�� C; � r -
PROPERTY. �� ` `` ,�
SIGNATURE / •_ ' �,1 ��?—,;� C�
OF PERMITTEE �
DISTRICT NO. ESSED BY
� . .
, IN�USIRIAL �
� VJASTE APPROVAL
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