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GE 917(REV.11/78)
: APPLICATIQN FOR PLUMBING PERMIT
' COUNTY OF LOS ANGELES UILDING AND SAFETY
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FOR APPLICANT i0 FILL IN IPRINT OR iYPE� 6UIlDING � C �
ADORESS '
NUMBER FIXTURE OR ITEM � FEE
LOCAUTY
3 WATERClOSES �
NEAREST
BAiH TUB � CROSS ST o
SHOLVER 01A'NER i
` ��-a/ �- o�Z/
LAVATORY � ADDRES$ �
SINK � CITY T�� . ���f/��
DISHWASHER �'Q CONTRACiOR � �
CLOTHES WASHER ADDRESS s"�J �L
SWIMMING POOL RECEPTOR
CITY TEL.NO. ��_�0�
LAWN SPRINKLER SYSTEM STATE LIC.
WATER HEATER LICENSE NO. � CLASS �
GASSYSTEM OUiLfTS 4—� APPROVALS DAiE i P RE
OUTlEi50VER UNDERSLABWORK � �
5 PER SYSTEM ROUGH PlUM81Nv `
� GAS PIPING V
j • GAS VENT q�
i �
HOT VVATER HEATER
PLUMBING FIXTURES �j
� GAS TEST v�i
i Pian check fee UTILITYCO.NOTIFIED a
PLUMBING PERMIT ISSUING FEE S �U
� TOTAL FEE if7) FINA� '�,..5'
v
Plon check applicant PLAN CHECK VALIDAiION
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Address
� Ciry Tel.No. _.- � ;t ` r.
� I 11EREBY ACKNOWlEOGE THFT I HAVE READ TNIS�PPLICATION AND ST�TE .
i iHATiHEA80VEI5CORRECiAhOPGREETOCONPLYWITHpLLCOUNTYOF�INGN[ES �� p O '! �O t �"
; ANDSTAfELAWSREGUUTINGPLUMBIhG. PERMITVALIDATION � � �
1 HEHEBY CERTIFY THAT I AM PROPENLY AEGISTERED ANO/OR LICENSED AS � h� �+' ,,r,��.�Ci
,RE�UIRED BY LOS AYGELES C011NTY A.VD 57ATE OF�A�IFORNIA OR TNAT I 11M THE
LEGAL OWNER OF,AhD INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDEN7IAL e�.. • �� r (�.,��,`
PROVERiY. � ' --
SIGNATURE � ^ � �.\' `/ — � 7
OF PERMITTEE
OISTRICT NO. O SEO BY
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INDUSTRIAL
� WASTE APPROVAL