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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION / n
MAKE CHECKS PAYABLE TO ADDLRESS ID 33 HT I /{� LUNE ?V
HARVEY T BRANDT, COUNTY ENGINEER LOC ALM 77�M LAF r e
FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEARECROSSST 126R. �LG
NUMBER FIXTURE OR ITEM ® FEE /� )+
200 OWNER /p/� zZ/
WATER CLOSET MAIL
BATH TUB 200 t ADDRESS
SHOWER 200 CITY joLg CIT TEL NO1g7,—/aQ
LAVATORY 200 CONTRACTOR
SINK 200 ADDRESS
DISHWASHER 200 CITY TEL NO
CLOTHES WASHER 2 DO STATE LIC
LICENSE NO CLASS
SWIMMING POOL RECEPTOR 200
DISTRICT NO GROUP ZONE PROCE88ED 8
LAWN SPRINKLER SYSTEM 200 :.
WATER HEATER 200 IyNR�,phOVAL
GAS SYSTEM OUTLETS INSPECTION RECORD
O
OUTLETS OVER 90 v
5 PER SYSTEM
CC
O
W
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N
Z
Plan Check fee Su RBVe1[R
PLUMBING PERMIT ISSUING FEE B
TOTAL FEE
APPROVALS DATE INSPECTOR [ SIGNATURE
Plan check applicant JA
ER SLAB WORK
Name GH PLUMBING
Address PIPING
City Tel No VENT
WATER HEATER
I HEREBY ACKNOWLEDGE THAT I HAVE READ TXIt APPLICATION
AND STATE THAT THE ABOVE IB CORRECT AND AGREE TO CMBING FIXTURES
WITH ALL COUNTY ORDINANCE$ AND STATE LAW[ REOUL
PLUMBING TEST
% XCR[BY CCRTI FY THAT I AM PROPERLY REGISTERED AITY CO NOTIFIED
LICENSED AS R[OUIREDBY LDSANGELES COUNTY ANO $TACALIFORNIA OR TXAT I AM THE LEGAL OWNER OF, AND RITRESIDE IN ME ABOVE DESCRIBED RESIDENTIAL PROPERTYL
T91ONATU RE
OF PERMI"CE
PERMIT VALIDATION CK M o CASH
PLAN CHECK VALIDATION CK M 0 CASH 69 6� IAN 15 5 0 7.5 0 ,&%