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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
WATER CLOSET NEAREST
BATHTUB
CROSS ST. t C
SHOWER OWNER P, UT
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LAVATORY MAILADDRESS VN, Yi
SINK CITY ;. TEL.NO� )y
DISHWASHER CONTRACTOR
CLOTHES WASHER ADDRESS
SWIMMING POOL RECEPTOR
CITY 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 d
GAS VENT
G
HOT WATER HEATER 0
PLUMBING FIXTURES 9
GAS TEST
Plan check fee UTILITY CO.NOTIFIED
PLUMBING PERMIT ISSUING FEE$ 17 � /✓
TOTAL FEE �0 FINAL
PLAN CHECK VALIDA
Plan check applicant TON
/
Name
Address
City Tel.No. z2 2'7 a,g A
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE fj
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES f O O 0 0 O 5
AND STATE LAWS REGULATING PLUMBING. PERMIT VALIDATION
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS 2 - - 1000
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE -
LEGAL OWNER OF,AND INTEND TO RESIDE IN THE ABOVE CRIBED RESIDENTIAL O .7 C Q a
PROPERTY. _/) r(7
SIGNATURE °Gi� O r
OF PERM ITTEE 6�
DISTRICT NO. ROCESSE BY
INDUSTRIAL
WASTE APPROVAL