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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN(PRINT OR TYPED BUILDING /
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NUMBER FIKTUREORITEM O FEE A
WATER CLOSET LOCALITY t4 _
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ADDRESS
SINK - OTY TEL NO
DISHWASHER CONTRACTOR-
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CLOTHES WASHER - ADDRESS
SWIMMING POOL RECEPTOR
CITY TEL NO '
LAWN SPRINKLER SYSTEM F
LICWATER HEATER ' E NO CLASS
GAS SYSTEM OUTLETSAPPROVALS DATE INSPECTOR 5 SICNATUROWLLTLETSQQVER R SLAB WORK -.7e5 PERSYSTEM H PLUMBINGIPINGO
ENTATER HEATER Q
ING FIXTURESEST Plan check fee Y CO NOTIFIEDPLUMBING PERMIT ISSUING FEE S
TOTAL FEE —
Plan dleck applicantAN CHECK VALIDATION
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EREBY ACKNOWLEDGE THAT I HAVE READ THIS APPL TION AND STATE ' ' 3 2 5 A U
E ABOVE 4 CORRECTANDAGREE TO COMPLY WITH ALL COONTY ORDINANCES
TE LAWS REGULATING PLUMSING PERMIT VALIDATION # • • • • 5 6 s
HERESY CERTIFY THAT I AN PROPEILLY REGISTERED AND/OR LICENSED ASD BY LAS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE 2 • • • !1 5WNER OF AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIALGTYq11I • • • • Q 2V MI 0��RMITTEE
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INDUSTRIAL
WASTE APPROVAL
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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANdELES BUILDING AND SAFETY
FOR APPLICANT TO FILL W(PRINT OR TYPEI BUILDING
S
NUMBER FIXTURE OR ITEM • FEE ADDRESS C7
- LOCALITY
WATER CLOSET
NEAREST
BATH TUB CROSS Si
SHOWER OWNER
LAVATORY MAIL T<11 I
ADDRESS O L
SINK CITY TEL NO
DISHWASHER CONTRACTOR
CLOTHES WASHER ADDRESS
SWIMMING POOL RECEPTOR //ES
CITY Ap I 2- TEL NO 2-
LAWN SPRINKLER SYSTEM TATEl
LIC
WATERHEATER LICENSE NO 7 3 OAS$
MONSOON
GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR S SIGNATURE
OUTLETS AVER UNDER SLAB WORK
S PER SYSTEM ROUGH PLUMBING '
GAS PIPING
GAS VENT V
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HOT WATER HEATER �
PLUMBING FIXTURES
GAS TEST Q
Plan check fee UTILITY CO NOTIFIED
PLUMBING PERMIT ISSUING FEE E '
TOTAL FEE FINAL �-
Plan check applicant PLAN CHECK VALIDATION
Nam 1 ,
Addreu V t
GryPrcA ATel No o @1 7 9 2 A
I HEREGY ACKNOWLEDGE TOUT I HAVE READ THIS APPLICATION AND STATE y# 0 0 0 0 0 5
THAT THE ABOVE IS CORRECT AND AGIIEE TO COMPLY WITH ALL COUNTY ORDINANCES
ND
ASTATE LAWS REGUUTING PLUMBING PERMIT VALIDATION 2 • • Q 0 O
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS
REQUMED BY LOS
LEGAL OWNEROF ANDS STATE
INTEND TO ESIDEINTHE ABOVE DESCRIBED RESIDENTIAL 0 0 0
PROPERTY 1 2- 13-78
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SIGNATURE
OF PERMITTEE
DISTRN:T PAOC ED BY
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INDUSTRIAL
WASTE APPROVAL '