HomeMy WebLinkAboutNo Permit Number (2202)76A667A
CE 817 (REV. 6/78)
s
APPLICATION FOR PLUMBING PERM
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN (PRINT OR TYPE)
NUMBER FIXTURE OR ITEM @
WATER CLOSET
BATH TUB
SHOWER
LAVATORY
SINK
DISHWASHER
CLOTHES WASHER
SWIMMING POOL RECEPTOR
LAWN SPRINKLER SYSTEM
WATER HEATER
GAS SYSTEM OUTLETS
OUTLETS OVER
5 PER SYSTEM
Plan check fee
PLUMBING PERMIT ISSUING FEE $
1 1 TOTAL FEE
Plan check applicant
Name
Address
City Tel. No.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
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
OF PERMITTEE
DISTRICT NO, PROCESSED BY
INDUSTRIAL
WASTE APPROVAL
BUILDING
ADDRESS
FEE
LOCALITY
NEAREST
CROSS ST,
OWNER
_ADDRESS
MAIL
CITY TEL. N
CONTRACTOR
ADDRESS
CITY TERN
-STATE LIC.
LICENSE NO. CLASS
APPROVALS DATE
APPROVALS
UNDER SLAB
ROUGH PLUMBING
GAS PIPING
EN
GAS VENT
GAS V
GAS
F R
WATER T ER HEATER
HOT WATER HEATER
HOT W
PLUMBING FIXTURES
STEST
UTILITY CO. NOTIFIED
NA L
FINAL
FINAL
PLAN CHECK VALIDATION
P L C C
PERMIT VALIDATION
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