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, APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES BUILDINGAND SAFETY
FOR APPLICANT TO FILL IN(PRINT OR TYPEI! ' .'BUILDING tt��
ADDRESS
NUMBER FIXTURE OR ITEM ® FEE.
LOCALITY ,
WATER CLOSET - "
NEAREST
BATH TUB CROSS ST
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SHOWER OWNER
LAVATORY MAIL d
ADDRESS
SINK CITY O-A TEL NO
DISHWASHER ` CONTRACTOR '
CLOTHES WASHER ADDRESS
SWIMMING POOL RECEPTOR 7
CITY �i� TEL NO
LAWN SPRINKLER SYSTEM STATE LIC
WATER HEATER LICENSE NO CLASS
GAS'SYSTEM OUTLETS APPROVALS DATE INSPECTOR'S SIGNATURE
OUTLETS OVER UNDER SLAB WORK
5 PER SYSTEM ROUGH PLUMBING _
• - GAS PIPING -
GAS VENT
im
HOT WATER HEATER
PLUMBING FIXTURES
GAS TEST
Plan Check fee UTILITY'CO NOTIFIED
,PLUMBING PERMIT ISSUING FEE$ '
TOTAL FEE FINAL
Plan check a pllcant PLAN CHECK VALIDATION
Name
Add res
CIt qJQ Tel No
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE - 8 8 7 7 A
THAT THE ABOVE IS CORRECT AND AGREE TO'COMPLY WITH ALL COUNTY ORDINANCES -
AND STATE LAWS REGULATING PLUMBING• t'' PERMIT VALIDATION
r 0 0 0 0 0 5
I HEREBY�CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS: „ '
REQUIRED BY LOS ANGELES COUNTY AND STATE OF,CALIFORNIA OR THAT I AM THE 2 O D 1 Z 00
LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL C 1 J-,
PROPERTY _
A'O a 1 300M
SIGNATURE
I OF PERMITT O u_
DISTRI O ROCESSEQ,BY
INDUSTRIAL
WASTE APPROVAL
17
CE 8
CE 17(REV.6/78)
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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING tr
NUMBER FIXTURE OR ITEM @ FEE ADDRESS
5423 Ft
WATER CLOSET LOCALITY "i` wo le ('"I t-v
NEAREST
BATH TUB CROSS ST.
SHOWER OWNER .T. L"lheven " e .
LAVATORY MAIL
ADDRESS
SINK CITY TEL.NO.
DISHWASHER CONTRACTOR .r u'� .,„ Co.
CLOTHES WASHER ADDRESS y
SWIMMING POOL RECEPTOR ---
CITY TEL.NO
LAWN SPRINKLER SYSTEM 599-0,928
STATE LIC.
WATER HEATER LICENSE NO. ' ° CLASS
GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR'S SIGNATURE
OUTLETS OVER UNDER SLAB WORK
5 PER SYSTEM ROUGH PLUMBING 0
GAS PIPING Lu
GAS VENT '!
U.
HOT WATER HEATER >.
OC
PLUMBING FIXTURES Q
GAS TEST 0
Plan check fee UTILITY CO.NOTIFIED
PLUMBING PERMIT ISSUING FEE$
TOTAL FEE FINAL
Plan check applicant
PLAN CHECK VALIDATI N
Name
Address
City Tel. No.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE u
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES �, 5
AND STATE LAWS REGULATING PLUMBING. PERMIT VALIDATION
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 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 RESIDENTIAL
PROPERTY.
I`
SIGNATURE f. i� '�'°"" YAM q'i.
OF PERMITTEE
DISTRICT N.O. PROCESSED BY
INDUSTRIAL
WASTE APPROVAL
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