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APPLIC ► '1 FOkPLUMAING PERMIT,
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN;PRINT OR TYPE) BUILDING
ADDRESS
NUMBER FIXTURE OR ITEM B FEE , /
WATERCLOSET LOCALITY 1,
NEAREST
BATHTUB CROSSST
SHOWER OWNER IdJoufu
LAVATORY ML
ADDRESS dn Is
SINK TY r TEL NO T
DISHWASHER CONTRACTOR J
CLOTHES WASHER D U
SWIMMING POOL RECEPTOR
CITY C 1 TEL NOS 6
LAWN SPRINKLER SYSTEM STATE L'� LIC '
WATER HEATERimiLICENSE NO
GAS SYSTEM S APPROVALS DATE INSPECTOR S SK:MAWRE
Op;RETS,OE ER UNDER SLAB WORK
55 ST ROUGH PLUMBING
GAS PIPING Q
GAS VENT V
HOT WATER HEATER �—�
001
PLUMBING FIXTURES
GAS TEST
Plan check fee / UTILITY CO NOTIFIED
PLUMBING PERMIT ISSUING FEES (/()
TOTAL FEE O FINAL ,}
Pion check applicont PLAN CHECK VALIDATION 2029.3 A
Nome %� • •`• • • 5
Address Z l Q Q Q
City Tel No Q
1 HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND ^Q O
THAT THE ABOVE LS CORRECT MIO(GREE TO COMPLY WITH ALL COUNTV ORD;NANC
AND STATE LAWS REGULATING PLUMBING PERMIT VALIDATION 0512-80
1 HEREBY CERTIFY THAT i AM PROPERLY REGISTERED AND/OR LICENSED AS _
REOUHIED By LOS ANGELES COU CALIFORNIA OR THAT I AM THE '
LEGAL OWNER OF AND INTER BESIDE IX THE DESCRIBED R DENTIAL
P
5 RE
OF PER
DISTRICT NO PROCESSED BY '
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INDUSTRIAL
WASTE APPROVAL
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