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CE 817'IREV.6/78)APPLICATION LUMBI PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
ADDRESS
NUMBER FIXTURE OR ITEM @ FEE
WATER CLOSET LOCALITY
NEAREST
BATH TUB CROSS ST.
SHOWER OWNER
LAVATORY MAIL
ADDRESS_
SINK CITY TL- TEL.NO.
DISHWASHER CONTRACTOR S
CLOTHES WASHER ADDRES L ,
SWIMMING POOL RECEPTOR
CITY t TEL.N
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
HOT WATER HEATER (�(�
PLUMBING FIXTURES Vt�
GAS TEST
Plan check fee UTILITY CO.NOTIFIED
PLUMBING PERMIT ISSUING FEE$ _ o
TOTAL FEE
FINAL
Plan check applicant PLAN CHECK VALIDATION
Name
Address
City Tel.No. -97 `I.7 A
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES }�f L' O O O O
AND STATE LAWS REGULATING PLUMBING, PERMIT VALIDATION
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS 2 O O 1 6.0 O
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE U
LEGAL OWN O ND(NTE RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL
PROPERTY. O ` O G C'
SIGNATURE 6011-80
OF PER TTEE
�ZED
INDUSTRIAL
WASTE APPROVAL