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APPLICATION FOR PLUMBING PERMIT
DUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING r
NUMBER FIXTURE OR ITEM • FE �i
1 10
WATER CLOSET LOCAII G' 4--
BATH TUB NEAREST
CROSS ST.
SHOWER OWNER Fr 2k iv k •J.
LAVATORY MAIL a
ADDRESS �
SINKQTY TEL NO.
DISHWASHER CONTRACTOR
CLOTHES WASHER
ADDRESS
SWIMMING POOL RECETTOR
QTY TEL NO.
LAWN SPRINKLER SYSTEM
STATE UC
WATER HEATER 90LKCEME NO. CLASS
m NO. GROUP 7
GAS S�YTSSfpEyMg� OUTLETS O _Z: n ZONE I BY a
5 PER SYSTEM INDUSTRIAL '�-f
WASTE APPROVAL OG
INSPECTION RECORD
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Z
Plan check fee
PLUMBING PERMIT ISSUING FEE$
TOTALFEE 7
Plan check applIcant
DATE WC PECTOR S SHMATURI
Name
UNDER SLAB WORK
Address ROUGH PLUMBING
city Tel.No. GAS PIPING
I HD1EeY Ac NAlOMti.mQE THAT I HAVE RIAD THIS APNMJCATIOM mw STAT( GAS VENT
THAT THE MOVE d CD"mcr AND AGRIII TO COWPLY WrrH ALL COUNTY ORD LNAIIC:ES
AND STATE LAWS REGULATING MX1459+G. HOT WATER HEATER
I HEREBY QRTrY THAT I PROPERLY FtNtSTIAED An/OR LNXNIM AS PLUMBING FIXTURES
REQU MED eY LOS ANG ETES AND STATE OF CALrONN A OR THAT I AM THE GAS TSI
LEGAL OWN"OF,AND I N RI3101 IN THE MOVE DEICRI UTTIAL
PROPERTY. OL LmUTY CO.NOT]RE[)
DIONATURL
OF I FINAL
PLAN CHECK VAUDAfICNJ nL LACE!+ PERMIT VALIDATION aL p cuH
G J t3 -5 O A mi
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