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APPLICATION FOR .PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING "000
NUMBER FIXTURE OR ITEM ® FEE ADDRESS
WATER CLOSET LOCALITYNEART �c� `G >
BATH TUB CROSSESST. (9-4 G�'����
SHOWER OWNER /1f �i6/QC�C, .TrJE•/r�E/l.
LAVATORY MAIL ADDRESS
D•, Z �E� O
ADDRESS cc�� ��// 2 �r
SINK CITY -7-6,1,t � CIT TEL.NO.2-�/ 49/Z
DISHWASHER CONTRACTORS
CLOTHES WASHER ADDRESS /'
SWIMMING POOL RECEPTOR CITY TEL.NO � �°Zf
LAWN SPRINKLER SYSTEM STATE �✓ LIC.
WATER HEATER LICENSE NO. v CLASS
GAS SYSTEM OUTLETS op v DISTRICT NO. ZONE ED BY
OUTLETS OVER �•
5 PER SYSTEM. INDUSTRIAL B.
WASTE APPROVAL O
' INSPECTION RECORD �
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7 �.
ZA
Plan check fee
PLUMBING PERMIT ISSUING FEE$ �a
TOTAL FEE
Plan check applicant
APPROVALS DATE INSPECTOR'S SIGNATURE
Name
UNDER SLAB WORK
Address ROUGH.PLUMBING
City Tel.No. GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE GAS VENT
THAT THE ABOVE IS CORRECT AND AGREE-TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING. HOTvATER HEATER
'I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/UR LICENSED AS PLUMBING FIXTURES �p /,,.�
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE GAS TEST Z /�y 70-4Z- -.
LEGAL OWNER OF.AND INT RESIDE IN THE AB E DESCRIBED RESIDENTIAL
PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE
OF PERMITTEE FINAL
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION ` tK. M.O. CASH
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APPLICATION FOIR PLU ING PERMIT
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COUNTY OF LOS ANGELES IJ
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO: BUILDING
RID Ess �I Q�� �IprGr� ✓`�
HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY
FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST .
' NUMBER FIXTURE OR ITEM ® FEE CROSS ST
WATER CLOSET
2.00 U OWNER f eis.
MAIL
BATH TUB 2.00 ADDRESS 41
SHOWER 2.00 oO CITY TEL. NO.
LAVATORY 2.00 CONTRACTO
N
SINK 2.00 ADDRESS
DISHWASHER a 2.00 CI �' TEL. NO.R
CLOTHES WASHER 2.00 STATE LIC
LICENSE NO. CLASS
2.00
SWIMMING POOL RECEPTOR
DIST�RICT NO.GROUP NE PR ESS BY
LAWN SPRINKLER SYSTEM 2,00 V+OB
WATER HEATER 2.00 INDUSTRIAL
WASTE APPROVAL
GAS SYSTEM OUTLETS 2.00 Q INSPECTION RECORD v
OUTLETS OVER
5 PER SYSTEM .30 �
O
u
W
a
N
Z
Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEE $
TOTAL FEE
APPROVALS DATE INSPECTOR'S SIGNATURE
Plan check applicant UNDER SLAB WORK
Name 1/ ROUGH PLUMBING
AddresS (.*,1:2GAS PIPING v
City Tel. No. GAS VENT
HOT WATER HEATER
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPOCATI&
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. GAS TEST
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED
LICENSEDAS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AIT MTEND TO
RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. FINAL
SITU RE -
EE
. .
PERMIT VALIDATION cK. MCASH
PLAN-CHECK VALIDATION CK. M.O. CAS
0 2lrp-'OCT 6 5 D 1 9.5 0 a�$8