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CE-817(REV 11/78)
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
NUMBER FIXTURE OR ITEM @ FEE ADDRESS
LOCALITY r
WATER CLOSET )
NEAREST
BATH TUB CROSS ST
SHOWER OWNERAL
Q ��
/ LAVATORY 13 ADDRESS J
SINK CITY TEL NO
DISHWASHER CONTRACTOR
CLOTHES WASHER ADDRESS
SWIMMING POOL RECEPTOR
CITY TEL NO
LAWN SPRINKLER SYSTEM STATE LIC
WATER HEATER q LICENSE NO CLASS
fGAS SYSTEM OUTLETS < A S In DATE INSPE9TOR'S,SIG NATURE
OUTLETS OVER a� UNDER SI,4&+NORK
5 PER SYSTEM ROUGH PLUMBING
fQ 9 GAS PIPING u
GAS VENT
HOTWATERHEATER u�-tf W
PLUMBING FIXTURES
GAS TEST IA
Plan check fee UTILITY CO NOTIFIED
PLUMBING PERMIT ISSUING FEE$ 7
TOTAL FEE FINAL
Plan check applicant PLAN I,HECK VALIDATION
Name
Address \�
City Tel No n 0 4 0.5 A
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES # O O O•O O.5
AND STATE LAWS REGULATING PLUMBING PERMIT VALIDATION
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS 2 - 2200
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE
LEGAL OWNER OF.AND INTEND RESIDE IN THE ABOVE D CRIBED RESIDENTIAL O O o 2 2. 0 Q U
PROPERTY
SIG RE OEI 9r 8 0
OF TTI±E
DISTRICT NO S
�D
INDUSTRIAL r
WASTE APPROVAL ti