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HomeMy WebLinkAbout7403A76A667A CE 817 (REV. 6/78) ©5 pW APPLICATION NG PERMIT COUNTY OF LOS ANGELES BUILD NG AND SAFETY FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING ' ,, ADDRESS , ,� s !s!%��' NUMBER FIXTURE OR ITEM O FEE LOCALITY q WATER CLOSET NEAREST CROSS ST. BATH TUB OWNER / //� 4/C` SHOWER frti.1 1,;c) LAVATORY MAIL ADDRESS Ct f f Ct f P' SINK CITY C ..�. TEL. NO ,,33- ) ,> fv DISHWASHER CONTRACTOR btr e f ai- L CLOTHES WASHER ADDRESS SWIMMING POOL RECEPTOR CITY TEL, NO. LAWN SPRINKLER SYSTEM STATE LIC. LICENSE NO, CLASS WATER HEATER APPROVALS DATE INSPECTOR'S SIGNATURE GAS SYSTEM OUTLETS UNDER SLAB WORK OUTLETS OVER 5 PER SYSTEM ROUGH PLUMBING GAS PIPING GAS VENT HOT WATER HEATER PLUMBING FIXTURES GAS TEST Plan check fee UTILITY CO. NOTIFIED PLUMBING PERMIT ISSUING FEE $ FINAL TOTAL FEE F PLAN CHECK VALIDATION Plan check applicant Name Address City Tel. No. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES PERMIT VALIDATION AND STATE LAWS REGULATING PLUMBING. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. SIGNATURE + •.,. CY. , r� OF PERM ITTEE DISTRICT NO. PRpCESSED BY INDUSTRIAL WASTE APPROVAL