HomeMy WebLinkAboutNo Permit Number (2203)76A667A
CE 817 (REV. 6/78)
ts -
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN (PRINT OR TYPE)
1
BUILDING - , -L ADDRESS �, �, ( ) � L� I k, -,
NUMBER
FIXTURE OR ITEM
FEE
LOCALITY
WATER CLOSET
NEAREST
CROSS ST. 0,
BATH TUB
OWNER
SHOWER
MAILADDRESS
LAVATORY
SINK
CITY TEL. NO.
DISHWASHER
CONTRACTOR
CLOTHES WASHER
ADDRESS
SWIMMING POOL RECEPTOR
CITY TEL. NO -
LAWN SPRINKLER SYSTEM
[STATE L 11
ICENSE NO. CLASS
S L, (I
WATER HEATER
—
11�
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
6-7
//1'
PLAN CHECK VALIDATION
Plan check applicant
Name
Address
City Tel. No.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THATTHE ABOVE ISCORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING.
PERMIT VALIDATION
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, ,1
b-
SIGNATURE
OF PERMITTE
DISTRICT NO. PROCESSED BY
INDUSTRIAL
WASTE APPROVAL
13C N 'Zol
Cd
22"
6r),