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Q (017 RE�11/78)
APPLICATION F PLUMB RMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
ADDRESS Lj /
NUMBER FIXTUREORITEM a FEE
-- - __ _ _ LOCALRY
-- - WATERCLOSEi _= _- - --- - -
NEAREST __ _1,�
BATH TUB CROSS SiSHOWER OWNERLAVATORY MAIL20 , CG��ADDRESS L� /�G-
SINK CITYem LE CI" TEL NO k
DISHWASHER CONTRACTOR
CLOTHES WASHER
ADDRESS .3 V S
SWIMMING POOL RECEPTOR
CITY 4:�V TEL NO 6 �Q
LAWN SPRINKLER SYSTEM STATE3 Q� 6 ��SS
WATER HEATER LICENSE NO
GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR S SIGNATURE
OUTLETS OVER UNDER SLAB WORK
5 PER SYSTEM ROUGH PLUMBING
GAS PIPING V
GAS VENT W
HOT WATER HEATER 0
PLUMBING FIXTURES
"CHECK
y�
Plan check fee Z
PLUMBING PERMIT ISSUING FEE b
TOTAL FEE D
Plan check opphcont
Name
Address
CITY Tel No f 8 2 3.7 A
I HEREBY ACNNOWLEDGe THAT I HAVE READ THIS APPLICATION AHO STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING PERMIT VALIDATION # • • • • ' 5
REQUIRED BYBLOS ANGELES COUNTY ANDSTATE FCALIFORNIA OR
ERTIFY THAT I AM P REGISTEREDERLY AND/ORLICENSED
IAM THE
• • 1 OO O
LEGAL OWNER OF AND INTEND TO RASIDE 1 HE ABOVE DESCRIBED RESIDEMTL 10005
PROPERTY I• N
SIGNATURE 1 2 1 3—7 9
OF PERM RTEE
DISTRIr P ED BY
INDUSTRIAL `
WASTE APPROVAL