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APPLICA ION F R PLUM NG PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO ADUILDING
DRESS
HARVEY T BRANDT, COUNTY ENGINEER LOCALITY ���/E C', yt �,gtJr
FOR APPLICANT TO FILL IN (PRINT OR TY PEI NEAREST G�a•� D
CROSS ST
NUMBER FIXTURE OR ITEM @ FEE
OWNER
2i WATER CLOSET 200 D MAIL
BATHTUB 200 Q ADDRESS /� N/'/4C4�0 A//cC,
d
/ SHOWER 200 (3 CITY 7 �--, C,f TEL NO �� Q
Z LAVATORY 200 0 0 CONTRACTOR 4/N
f SINK 200 00 ADDRESS
DISHWASHER 2 00 j} CITY TEL NO
I
CLOTHES WASHER 2 00 U STATE LIC
SWIMMING POOL RECEPTOR 200 LICENSE NO CLASS
DISTRICT NO GROUP ZONE CESSKD BY
LAWN SPRINKLER SYSTEM 2 00 5, 09 y <;z— 3 t
WATER HEATER 2 00 3INDUSTRIAL
WASTE APPROVAL
GAS SYSTEM ��OUTLETS 2 00 v a
INSPECTION RECORD
OUTLETS OVER
5 PER SYSTEM 30U
1-t 7Vld av T- &41<
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Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEE $
TOTAL FEE
APPROVALS DATE INSPECTOR S SIGNATURE
LRESIDE
check pllcant
UNDER SLAB WORK
ROUGH PLUMBING
ss GAS PIPING
el NO GAS VENT
HOT WATER HEATER
EREBY ACKNOWLEDGE THAT I HAVE R AD THIS APPLICATION
TATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
ALL COUNTY ORDINANCES AND STATE LAWS REGULATING .2�7
ING GAS TEST
EREBY CERTIFY THATLOAM AM PROPERLY REGISTERED AND/OR UTILITY`CO NOTIFIED
ED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
RNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO
IN THE ABOVED RIBED RESIDENTIAL PROPERTYFINAL_ATU RE /i UPERMITTEE -QaJ1. -CrC
PERMIT VALIDATION cK M 0 CASH
PLAN CHECK VALIDATION CK M 0 CASH
- 2 9 1 3 ?.5 0 s�*