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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO BUILDING
ADDRESS
HARVEY T BRANDT COUNTY ENGINEER LOCALITY
FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST
NUMBER FIXTURE OR ITEM @ FEE CROSS ST
OWNER �R
WATER CLOSET 200
MAIL
BATH TUB 200j ADDRESS
SHOWER 20 CITY TEL NO
20CONTRACTOR
SINK 2 0 ADDRESS
DISHWASHER 240 CITY TEL NO
CLOTHES WASHER 2 fO STATE LIC
SWIMMING POOL RECEPTOR 2 0 LICENSE NO CLASS
DISTRICT NO GROUP ONE PR ESS D B
LAWN SPRINKLER SYSTEM 2 0 6—o,5
Y-- —I
WATER HEATER 2 0 INDUSTRIAL
WASTE APPROVAL CL.
GAS SYSTEM OUTLETS 2 03 U INSPECTION RECORD V
OUTLETS OVER
5 PER SYSTEM 90 OtQT/OBJ O
Z lAle 73
LJ
a
Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEE $
TOTAL FEE
Plan check applicant APPROVALS DATE INSPECTOR 9 91GNATURE
UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
City Tel No GAS VENT
I HEREBY ACKNOW EDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING GAS TEST
I HEREBY CERTIFY THAT LI AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED
LICENSED AS REQUIRED BY OS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INT E TO
RESIDE IN THEAB E CRI ED RESIDENT I PROPERTY FINAL J7
�7
SI G N A TU RE
I
OF PERMITT
ERM T VALIDATION cK o cases
PLAN CHECK V LIDATION c M o cases
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