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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN(PRINT OR TYPEI BUILDING
ADDRESS
NUMBER FIXTURE OR ITEM ® FEE
WATER CLOSET Ml LOCALITY
V(/ NEAREST ,
BATH TUB CROSS Si
SHOWER OWNER —
LAVATORY MAIL
ADDRESS
SINK CITY TEL N r
• DISHWASHER CONTRACTOR
CLOTHES WASHER ADDRESS
SWIMMING POOL RECEPTOR
CITY ` TEL _
417
LAWN SPRINKLER SYSTEM STATE LIC
WATER HEATER -, LICENSE NO CLASS
GAS SYSTEM OUTLETS "7 APPROVALS DATE INSPE To SSIONATURE
OUTLETS OVER UNDER SLAB WORK
5 PER SYSTEM ROUGH PLUMBING
GAS PIPING 0
JGASVENT U
WATER HEATER 3-ft?o
R✓ O�
MBING FIXTURES — V
S TEST
N
Plan check fee ITYCO NOTIFIEDPLUMBING PERMIT ISSUING FEETOTAL FEE AL A�"��"(p� �.
Plan check applicantPLAN CHECK VALIDATION
Name
Address
CIry Tel Wo
1 HEREBY ACKNOWLEDGE AT HAVE READ THIS APPLICAT ON ANO STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING PERMIT VALIDATION �g 7 1'Q 751
1 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 2 IF - 2200
SIGNATURE
22003
OFPERMITTEE
DISTRICTNO ED BY I Q09'-79
5, a 8
INDUSTRIAL
WASTE APPROVAL
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