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APPLICATION FOR PLUMBING PERMIT
READY FOR RNAL OP mom
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN(PRINT OR TYPE] BUILDING
NUMBER FIXTURE OR ITEM ® FEE
ADDRE!�,.Q Olt/ 11�6 Of E
WATER CLOSET LOCALITY
BATHTUB NEAREST
CROSS ST. S
SHOWER OWNER
LAVATORY MAIL
ADDRESS
SINKi iEL.NO.L
DISHWASHER CONTRACTOR
CLOTHES WASHER E. GRAP4 DAVE-
RS '
SWIMMING POOL RECEPTOR
D CITY,kiWPLE fEL.NC��- 7070
LAWN SPRINKLER SYSTEM
STATE LIC.
WATER HEATER LICENSE NO. GLA
GAS SYSTEM OUTLETS DISTRI / O. UP P CESSE BV
Y
OUTLETSOVER �(J O
5 PER SYSTEM INDUSTRIAL U
WASTE APPROVAL
INSPECTION RECORD
U
W
d
Z
Plan check fee
PLUMBING PERMIT ISSUING FEE$
TOTALFEE dloir
Plan check applicant
APPROVALS DATE INSPECTOR'S SIGNATURE
Name
UNDER SLAB WORK
Address ROUGH PLUMBING
City Tel.No. GAS PIPING
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING, HOT WATER HEATER
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR LICENSED AS PLUMBING FIXTURES _
REQUIRED BY LO5ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE GAS TEST
LEGAL OWNER OF.AND INTEND 0 RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL
PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE
OF FINAL
PLAN
PLAN CHECK VALIDATION CK. M.o. CASH PERMIT VALIDATION CR. M.o. CASH
�� 568�rulr, 21 5 u 10.00 Au
76A607-CESI710-60 flT
APPLICATION FOR PLUMBING PER
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY.'DIMION BUILDING�r" O y. �P�EviC/RUE
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
WILLIAM A. JENSEN, SUPT OF BUILDING
.. , LOCALITY
FOR APPLICANT TO FML IN NEEAARSOSS TT.
NUMBER FIXTURE OR ITEM
OWNERz7't
WATER CLOSET MAIL
I. HATH TOB / ADDRESS .. .
/ CITY .•. -TEL NO. .
SHOWER
CONTRACTOR4e,9x TE
LAVATORY ADDRESS�56 e;?
SING f
DISHWASHER •` Cm�ONTC�.Cff�ie TEL.
CONTRACTOR'S - STA
LAUNDRY TOB REGISTRATION NO. % w� J"'J' COUNTY
DISTRICT NOE PCE
CLOTHES WASHER . G�R7OyP ZQNSS B
WATER HEATER
GAS SYSTEM INDUSTRIAL _
WASTE APPROVAL }
INSPECTION RECORD . d
/3/Gari ( §! 1/.l �i,� .
O ® $1.00 PER ITEM ' �1 /j /7 i dLE/ltd_
/ OR FIXTURE APPROVALS 'DATE)
n^ INSPECTOR'SqIJNA URE
PERMIT 8 2 00 UNDER SLAB WORKGDS-
/ ROUGH PLUMBING I /.... - z)
TOTAL FEE -r-.;5'p4
/�� GAS PIPING I- Y ~' �
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
1 HEREBY CERTIFY THAT RLY REGISTE O R PLUMBING FIXTURES p • �'
LICENSED AS REOUIRED 09 ANG NO STAT F N!`
CALIFORNIA OR THA AM H GA W p OF TH OVE
DESCRIBED REBID IAL P TITY CO. NOTIFIED '/���G� /
SIGNATURE I
OF PERMI FE
OVALIDATION ROBERT A. WOOOD
M.0. CASH SUPERVISING MECHANICAL ENG'R
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