HomeMy WebLinkAbout1737A (19) i �76A6h7A �
CE 8l7(REV.11/78)
APPLICATtON FOR PLU M B tNG PE RM IT
COUNTY OF LOS ANGELES BU{ DING AND SAFETY
�33 -,� ,33/�5G
FOR APPLICANT TO FILL IN IPRtNT OR TYPEi BUILDING r
ADDRESS �D c
NUMBER FIXTURE OR ITEM � FEE
WATER CLOSET � LOCALITY
N EAREST /���� -
BATH TUB � CROSS ST.��(/'�L2
SHOWER OWNER �7�, ,
C.1� �+C./
IAVATORY �}-�, '`��� �y�
(/V ADDRESS � ��
SINK 3 � CliY �� �
TEL N �7.J �di�/
DISHWASHER v ls CONTRACiOR '
CIOfHES WASHER _ __ �l1 AODRESS �33,s�
SWIMM�NG POOL RECEPTOR
�IT . TEI.N0�6�'�Q�
LA�:'N SPR4NKLER SYSTEM /J
1 WATER HEATER /f�ti LIC€NS€NO.[ / y.�� C A55 � ��j
v V
GASSYSiEM OIJTL€TS ,[�, APPROVALS OATE N59BCTOR'SSIGNATURE
�� u
OUTIETS OVER IiNDER SLAB WORK �
5 PER SYSTEM RpUGFt PLUMBING �� g
GAS PfPfNG Q
GAS VENT V
6C
HOT WATER HEATER O
�
� -- PlvPr1Blr::�fiXTURES � �
GAS TEST �" 4
Plan check fee UTILITY CO.NOTIFIED �
PLUMBiNG PERMIT{SSUtIVG FEE$ �'7J r
TOTAL FEE � FrNa� " � 9'
�lan chectc oppticcrnt Pt,AN CHECK VAiIDATION �
Name
A��dress
..:... . ....
Ci�y Tel.No.
_ _. �
� 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND S7ATE � � � '
TNAT THE ABOVE IS CORRELT ANP AGREE TO COMPLY W ITH ALL COUNTY OROINANCES .�, ;,: •
PERMlT VALIDAIlON `." ` � ` "
AND STA7E LAWS flEGULATING.PLL'AtBING_.... . .... . . . . . . • .
_ I HEREBY CER7IFY T}IAT..I AM PROPEBLY.REG15iEHED ANDl�R 41LFNSED AS �- � I „� b :� {�`
REOUIRED BY l05 ANGELES COUNTY AND STATE OF CALIFOFNIA OR THAT f AM TME ' ` � �
�IEGAL OWNEH OF,AND INTFN�TO RESIDE�IN THE ABOVE DESCRfBED RESI�ENTIAL �
PROPERTY. �� • ' '
SIGNATURE �� ' '' �� �. !'•„_,'; ;� ..
OPPtRMITTEE � �� � '
DISTRICT NO. PROCESSED BY
� 1
INDUSTRIAL
V1'ASTE AVFHOVAL