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7GA667 (CE 817) 1/75
APPLICATION F PLUM NG PERMIT
- COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
MAKE CHECKS PAYABLE TO ADDRESS �;� (j�t► "�
HARVEY T BRANDT, COUNTY ENGINEER �.
LOCALITY "t f p
FOR APPLICANT TO FILL IN (PRINT OR TYPE) CROSS NEARESTT �^� °
NUMBER FIXTURE OR ITEM @ FEE c
OWNER A�� S0. e_
WATER CLOSET Q U
MAIL
BATH TUB 2 ADDRES IS Q
SHOWER 2 0 CITY G TEL NO
LAVATORY 2 p Qd CONTRACTOR
SINK ba 2 0 ADDRESS
DISHWASHER 2 0 CITY TEL NO
CLOTHES WASHER 2 00 STATE LIC
LICENSE NO CLASS
SWIMMING POOL RECEPTOR 2 p
DISTFjICT QNO GROUPONE PRO ESSE BY
LAWN SPRINKLER SYSTEM pp �16�U �� �
WATER HEATER V 00 INDUSTRIAL
WASTE APPROVAL c
GAS SYSTEM OUTLETS 00 INSPECTION RECORD
OUTLETS OVER
5 PER SYSTEM O
F-
U
W
a.
N
Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEE $
TOTAL FEE U
APPROVALS DATE INSPECTOR S 31GNATURE
Plan check applicant UNDER SLAB WORK .7
Name PA u Ci c ROUGH PLUMBING -4-3-W r
Address(57761 L D IS 7
GAS PIPING
CityP�r�� Q Tel NO GAS VENT
HOT WATER HEATER
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
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 I AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED
LICENSED AS 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 RESID NTIAL PROPERTY
SIGNATU RE FINAL �� +�!
OF PERMITTEE GI
PERMIT VALIDATION CK M o CASH
PLAN CHECK VALIDATION CK M o CASH
36 Dit"DAPR 15 5 D 1 050
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