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APPLICATION FOR PLUMBING PERMIT
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COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING83 1
NUMBER FIXTURE OR ITEM ® FEE ADDRESS
2 WATER CLOSET LOCALITYTemple t Unit-
NEAREST
A
6 00 NEAREST
BATH TUB 00 CROSS ST
SHOWER 00 OWNER Fairhaven CO
LAVATORY MAIL
6 00 ADDRESS
SINK CITY TEL NO
DISHWASHER CONTRACTOR DorseyPlumbing Co.
CLOTHES WASHER ADDRESS
800 Palomares
SWIMMING POOL RECEPTOR
CITY me TEL NO —0828
LAWN SPRINKLER SYSTEM
X TATELIC
WATER HEATER 00 'LIC NSE NO 31542'1 CLASS B, C-36
GAS SYSTEM OUTLETS APPROVALS DATE INSPECT R S SIGNATURE
OUTLETS OVER UNDER SLAB WORK -�- �U
5 PER SYSTEM ROUGH PLUMBING 2- .v pGoir R
a
GAS PIPING Q
GAS VENT ..a. V
HOT WATER HEATER v 0
PLUMBING FIXTURES
' GAS TEST
l'Plan check fee UTILITYCO NOTIFIED + v Z
PLUMBING PERMIT ISSUING FEE$ 1 7100
TOTAL FEE 00
FINAL
Plan check applicant i , PLAN CHECK VALIDATION t
Name
Address
'City Tel No a 0 0 9 3 A
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES f• • • • • 5
AND STATE LAWS REGULATING PLUMBING PERMIT VALIDATION
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS 2 • • 3 7 0 0
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 ( Z O0(1 S
PROPERTY • • • J G1
1
SIGNATURE 0&28-80
'OF PERMITTEE
DISTRICT NO P CE ED BY r
Sid d i
INDUSTRIAL
WASTE APPROVAL
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