HomeMy WebLinkAbout1733A (19) i �76A667A
CE 817(REV.11/78)
APPLlCATION FOf� PLUMBING PERMIT
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COUNTY OF LOS ANGELES B ILDING AND SAFETY
��� 3s�- � 33�b s�
FOR APPLICANT TO FILL IN iPRINT OR TYPE! ADDRE55 � ��"Q
NUMBER FIXTURE OR ITEM � FEE /���� �, n
`' LOCALITYOQ�'��//"� �...0�
WATER CLOSET �11
NEAREST
BATH TUB � CROSS S7.
SHO W E R O W{VER
� LAVATORY � ADDRE55 ��/ -� �
SINK 3 � ClTY FEC.N . �/�7j�/
DISHWASHER 3 �'D CONTRACTOR
_ CL07HES WASHER ADDkE55 1335�
SVVIMMING POOL RECEPTOR
CiTY TEL.NO E,3_y�Co�
LAWIV SPRINKtER SYSTEM �J ,[�
WATERHEATER � LICENSeNO. �/ _��U CA55� C"�
GASSYSTEh1 s�OJTLETS � APPROVALS DAT I PEE��B;�{4j�,$�
uNDER SLAB WORK � �
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S�PER 5Y�EMR RO:lGH PCUMBING /" � �
GA�PiPiNG V
GAS VENT L+C
HOT WATER HEATER � i
�._ _._....._..._.._ Pl:iM81NG FIXTUkES i� f
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__ GAS TEST �
Plan check fee unurrco.rvonFiEo —
PLUMBING PERMIT ISSU�NG FEE$ A�
FINAL � ��L �
, TOTAL FEE
� PLAN CHECK VALIDATION
Plon check applicant '
Name
Address
City TeL No. i �,' ` „
I HEREBY AGRN6WLEDGE TFtAT I NAVE READ TNIS APVLICIITION ANU S7ATE
TNAT iHE 0.90VE IS CORRECT AND AGREE TO COMPLY WITH All COUNTY ORD�NANCES pEkMIT VALIDATION .� ' a � Q p ��
ANO STAI'E LAWS RE6ULATING PLUMBING. i� �
1 MEREHY CERTIFY TMAT 1 AM PNO�ERLY REGiSTERED AND/OR ttCEN5E9 A5 { `: 'k �, �, ,;�, ��
REaVIREb 9Y COS�IJb�lES CCSUIiTY AFIU S7A7E OF CIiLIFT3RNIA OA?NA7 I Jllif YF1�
LEGAL OWN�R OF.AND iNTEND TO RESIDE tN THE ABOVE DESCAl6ED'RE51DENtIAL ,,, �.. J .�� ` -
PROPERTY.
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