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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES '
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO BUILDING
ADDRESS j 3
HARVEY T BRANDT, COUNTY ENGINEER LOCALITY
FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM @ FEE
� � OWNER
WATER CLOSET 200 c� C)U MAIL
BATH TUB 200 ' (�� ADDRESS v
SHOWER 200 CITY 0 CICL NO
r
LAVATORY 200 � CONTRACTOR
SINK 2 00 ADDRESS aJ
DISHWASHER 2 00 CITY � TEL N tIf
CLOTHES WASHER 2 00 STATE LIC
LICENSE NO P �j CLASS
SWIMMING POOL RECEPTOR 2 00
DISTRICT NO GROUP ZONE PROCESSED BY
LAWN SPRINKLER SYSTEM 2 pp S;o �--y /c/—,//
WATER HEATER 200 r O INDUSTRIAL / �C
WASTE APPROVAL
GAS SYSTEM OUTLETS 2 00 () C-) INSPECTION RECORD
OUTLETS OVER �� �I U
5 PER SYSTEM 30 �r G� � �
f VICE /J� CjK 7� u� w
C_
rn
z
/-I� V M 2 s��vac
Pian check fee See Reverse
PLUMBING PERMIT ISSUING FEE $ 50
TOTAL FEE
APPROVALS , DATE INSPECTOR 3 SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING ., _
Address GAS PIPING
City Tel NO GAS VENT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING `�', ��
PLUMBING GAS TEST a!T
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE L GAL OWNER OF AND INTEND TO
RESIDE IN THE ABOVE DESCRIBED SIDENTIAL PROP€R� FINAL
SIGNATU RE '/ L
OF PERMI ZTEE ' A
PERMIT VALIDATION cK M o CASH
PLAN CHECK VALIDATION CK M D CASH ,
41 6,nFr ,�2 5 U 1950 '6
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