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^APPLICATION FOR PLUMBING PERMIT
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
L S
NUMBER FIXTURE OR ITEM ® FEE ADDRESS _
WATER CLOSET LOCALITY
BATH TUB NEAREST
CROSS ST
SHOWER �� OWNER_�?//,j
LAVATORYMAIL
�J (J ADDRESS --�
SINK CITY TEL NO,-,28 `4
DISHWASHER CONTRACTOR
CLOTHES WASHER
ADDRESS
SWIMMING POOL RECEPTOR
CITY TEL NO
LAWN SPRINKLER SYSTEM
STATE LIC
/ WATER HEATER LICENSE NO CLASS
GAS SYSTEM OUTLETS DISTRICT NO GROUP 3 ZONE PRO ED
OUTLETS OVER 0 CC �C V
5 PER SYSTEM INDUSTRIAL
WASTE APPROVAL 0
INSPECTION RECORD CD
Plan check fee
PLUMBING PERMIT ISSUING FEE$ -7 py
TOTAL FEE
Plan check applicant
Name APPROVALS DATE INSPECTOR S SIGNATURE
UNDER SLAB WORK J
Address ROUGH PLUMBING 12-27-70
City Tel No GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT 9
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES HOT WATER HEATER y ar—
AND STATE LAWS REGULATING PLUMBING
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE GAS TEST
LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL
PROPERTY UTILITY CO NOTIFIED
Ste.
SIGNATURE
OFPERMITTEE FINAL
PLAN CHECK VALIDATION CK M o CASH ERMIT VALIDATION 2CK '/M Q CASH
730C4U6 y 5 U 8 ❑ Jaye