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APPLICATION FOR PLUMBING PERMIT
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PLUMBING PERMIT ISSUING FEE$ ti
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Name APPROVALS DATE INSPECTOR S SIGNATURE
UNDER SLAB WORK
Address K K 4--1Vc5 VF ROUGH PLUMBING
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT I vv
THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCE HOT WATER HEATER
STATE LAWS REGULATING PLUMBING \
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED ASI PLUMBING FIXTURES A ,.
IRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE# GAS TEST
L OWNER OF AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL
ERTY ` UTILITYCO NOTIFIED
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PLAN CHECK LID ION CK M O CASH i PERMIT VALIDATION CK MO CASH
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