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APPL ATION R PLU ING PERMIT
COUNTY OF LOS ANGELES BUILDING AND'SAFETY
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
201
NUMBER FIXTURE OR ITEM ® FEE ADDRESS �,
WATER CLOSET LOCALITY °
NEAREST
BATH TUB CROSS ST. `
SHOWER OWNER t LZ `
LAVATORY ADDMAILRESS S
SINK • CITY ..) G TEL.NO..
DISHWASHER CONTRACTOR
CLOTHES WASHER ADDRESS
SWIMMING POOL RECEPTOR
CITY TEL.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
{ p/1 GAS PIPING
Y' GAS VENT 1119
�A
HOT WATER HEATER
PLUMBING FIXTURES
GAS-TEST
Plan check The UTILITYCO:.NOTIFIED g
PLUMBING PERMIT ISSUING FEE$ /J
TOTAL FEE FINAL
Plan check applicant '
PLAN CHECK VALIDATION v
Name
Address
City Tel.No. 1177 }}�'� n
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE C 0 V7 0.O A
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS-REGULATING PLUMBING.. PERMIT VALIDATION # O O O O O 5 ,
I 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 2 - 011(100
LEGAL OWNER OF;AND INTEND TO RESIDE-IN THE ABOVE DESCRIBED RESIDENTIAL
PROPERTY. 0 0 0 1 0 o O V
SIGNATURE
OF PERMS E • 11
' .Q, 0-78
DISTRICT NO. P OCESS BY
INDUSTRIAL
WASTE APPROVAL
76A667 17 25M SETS 7-46 APPLICATION FOR PERMT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGEL]W PLUMBING
WM.J. FOX.CHIEF ENGINEER
NA E 0 INSTALLATION DISTRICTWO: GROUP O PERMIT o.
OUGN • FIXTURESCOMPLETE
HEATER CESSPOOL HSEPTIC TANK RECEIVED BY READY FO DATE ISSUED
FIRST INSPECTION
GAS- MISCELLAN US 7_w d _,�L:)—.1
APPLICANT FILL IN HEAVILY OUTLINED PORTIJDN ONLY
JOB
g NAM 'rJ�GLy�JL V �` Q ADDRESS Z
15
ADDRESS.*eb� (.FiK�ydG(J'UG ' LOCALITY 4
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d CITY (.,A ok .. TEL.NO. CROSS ST.
COUNTY. °y
LICENSE NO. J EXPIRES m NAME
LOCATION OF SEPTIC TANS, OR CESSPOOL Z AMA
D ARMS
NORTH O
CITY 646EL.NO.
1 AM THE LzaAjL POSY SO OF T 6 OVB LOS
ANGELES COUNTY CERTIR�I O` U PI TION.
` PLUMBRR
I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED
ABOVE.
OWNER
CORRECTIONS
SOUTH "1'Y 'i "'1
DESCRIPTION OF WORK z
BATH TUB FURNACE V
SHOWER DISHWASHER G
LAVATORY REFRIGERATOR
-KITCHEN SINK WATER SOFTENER
FLOOR SINK SAND TRAP
LOP SINK FLOOR DRAIN
W H TRAY URINAL APPROVALS
ATER CLOSET DRINKING FOUNTAINDATE INsPR6TOR•e MAKE
WATER HEATER DENTAL LAVATORY ROUGH PLUMBING I
ETER GAS SODA FOUNTAIN GAS PIPING I I'
OUTL
OAS VENT
CESSPOOL I
TOTAL NUMBER OF FIXTURM SEPTIC TANK i
CESSPOOL SEPTIC TANK SEWER I
UTILITY GO.NOTIFIED I
TOTAL FEE'
RIVAL