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76A667A �
CE 817(REV.11/78)
APPLICATION F4R PLUMBING PERMIT
COUNTY OF LOS ANGELES UILDING AND SAFETY
. c� 35�� � 33/d �
FOR APPLICANT TO FILL IN IPRINT OR TYPE; BUILDING �
ADDRESS ��� O �
NUMBER FIXTURE OR ITEM � F E /�
LOCAIITY /,/)�„ /
WATER CLOSEi �cr�V
NEAREST
BATH TUB � CRO55 ST.
/ SHOWER � OWNER !�
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LAVATORY MAIL n
� ADDRESS�"�� �� �
� SINK CITY TE�� . !i /�� I
DISHWASHER �'
CONTRACT�R � � I
CLOTHES WASHER �� �
ADDRESS�33Sv
SWIMMING POOL RECEPTOR ��a-�� /
CITY TEL.NO. p
tA4VFV SPRINKLER SYSTEM / /
WATER HEATER � LICENSE NC. ! (��b� CLAS$1! G�-�
APPROVALS DA E P�CTOR'S SIGNATURE �
GAS S�'SIEhS S— OUTLETS � . .�,.
OIiTLETSOVER uNDtRSLAB WORK � ; ���F •
5 PER SYSTEM RpUGH PLUMBING f , a �
GAS PIPING � ('� �
GAS VENT V
�
HUT WATER HEATER O
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PL'UMFsi1VG FiXTURES 4�
GAS TEST � �
P{an check fee UiILITY CO NOTiFfED �
PLUMBING PERMIT ISSUING fEE$
TOTAL FEE � � FINAL -- a
P'on check cppiicant
PIAN CHECK VALIDATION
Name
Address
City Tel.No. . ! . ,
i HEREBY ACK40WLEDGE THAT 1 NAVE READ THIS APPLICATION AYO STATE �
; THAT THE ABOVE IS CORRcCT AND AGREE TO COMPLY WITH p�L COUNTY ORDINANCES i: 'E � � � � �,
AND 5T11TE LRWS REGULATING PLUMBING. PERMIT VALIDATION [
I NEREBY CERTIFY THAT I AM PROPERLT REGISTEREO'1C1t�'Z7R LfCEN5ED KS � �" �� �+ (- i, „ .
REUUfRE'(1'8Y LffS iC1dGE1,�S CCfbMll'Y ARb SYIITE OF CI1LlF�1. ' YHAT I 1(M YWE � . '
�E611E76WNEfr�F.�A'171Y R17E�ND TO"R�Sf6�IF1 Tf1E 1fgS�� � . .�{J fi�3iCl�t�fT1At � '�:'s '.- u '.. f ::`. ,'�.�.
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