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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
WATER CLOSET LOCALITY ' le i
NEAREST
BATH TUB CROSS ST: . r
SHOWER OWNER r C-11 K N- .CIYA1-'d_y... j15-
MAIL
LAVATORY ADDRESS 0 �O
SINK CITY Ga ze ; TEL.NO.,?
DISHWASHER CONTRACTOR r
CLOTHES WASHER ADDRESS
JC rVr L
SWIMMING POOL RECEPTOR
LAWN SPRINKLER SYSTEM CITYSg,,rd "AJ1k'4 TEL.NO
STATEr� LIC.
WATER HEATER LICENSENO,cJ CLASS c�
GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR'S SIGNATURE
OUTLETS OVER UNDER SLAB WORK
5 PER SYSTEM ROUGH PLUMBING j �l
Cd 7' 7-d ` GAS PIPING '-
r GAS VENT �g
HOT WATER HEATER 0
PLUMBING-FIXTURES
GAS TEST us
Plan check fee UTILITY CO.NOTIFIED
PLUMBING PERMIT ISSUING FEE$
TOTAL FEE FINAL s�
Plan check applicant �LAN CHECK VALIDA N
Nomas Q/•J �
Address `
City Tel.No. 2 O 8 1,3.A
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE •# O O 0,0 0 5
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING. PERMIT VALIDATION
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS 2 - o 1 GOD
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 O o 0 1 O,O O 5
PROPERTY.
SIGNATURE "� 0618-8
O
OF PERM ITTE a
DISTRICT NO. OCESS�FD BY
INDUSTRIAL
WASTE APPROVAL