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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL-IN(PRINT OR TYPE) BUILDING
ADDRESS
NUMBER FIXTURE OR ITEM ® FEE
LOCALITY tie_
�.
WATER CLOSET
NEAREST
BATH TUB CROSS ST. `
SHOWER OWNER
LAVATORY MAIL.
ADDRESS
SINK CIT `,i 0_1 'L Y TEL.NO
gIM
CAW]
DISHWASHER CONTRALTO t
CLOTHES WASHERADDRESS �tjS
SWIMMING POOL RECEPTOR n I
CIT TEL.NO
LAWN SPRINKLER SYSTEM STATE 1 LIC.
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WATER HEATER LICENSE NC1 CLASS
GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR'S SIGNATURE
OUTLETS OVER UNDER SLAB WORK
5 PER SYSTEM ROUGH PLUMBING
GAS:PIPING
GAS VENT
HOT WATER HEATER
PLUMBING FIXTURES
GAS TEST • Ss usus
Plan.check fee UTILITY CO.NOTIFIED g
PLUMBING PERMIT ISSUING FEE$ o
TOTAL FEE' ei FINAL
Plan check applicant PLAN CHECKVALIDATION
Name
Address �.
J31 424A
04' \ Tel.No
• 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE.
THATTHE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALLCOUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING. PERMIT VALIDATION 2 0 0 1300
I HEREBY CERTIFY THAT 1:AM PROPERLY REGISTERED AND/OR LICENSED AS
REOUMED BY LOS ANGELES.COUNTY AND STATE OF CALIFORNIA OR THAT I.AM THE O O O 13.O 0 U
LEGAL OWNE AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL
PROPERTY. f 1 1,2 O r 7
SIGNATURE
OF PERM( E
Q&'�
DISTRICT NO. P CESSEO BY'
®i
INDUSTRIAL
WASTE APPROVAL
76A667A(GE 81781-11/78
APPLICATION - O PLU M B ING` PE MIT
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO-FILL IN(PRINT ORTYPE) BUILDING. 74
NUMBER FIXTURE OR ITEM ® FEE ADDRESS '574
WATER CLOSET LOCALITY LIVE-
. �/�� ►�/l/l
BATH TUB CROSS ST.NEAREST . v I�
SHOWER, OWNER D N
LAVATORY MAIL
ADDRESS
SINK CITY TEL.NO. Q
DISHWASHER COI QIF`C INSTALLERS
CLOTHES WASHER ADDIEW20'E. GRAN®AVE.
,SWIMMING POOL RECEPTOR
CIT
AWN SPRINKLER SYSTEM Q`STATE �� CAL1f NO. qa-9 Q
WATER HEATER , „LICENSE NO. I (/ CLASS
GAS SYSTEM OUTLETS DISTRICT NO. GROUP NE P CESSE Y
OUTLETS OVERI
S PER SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
09z
Plan check fee '
PLUMBING PERMIT ISSUING FEE$ (,
TOTAL FEE ' w
Plan check applicant _
APPROVALS DATE INSPECTOR'S SIGNATURE
Name
UNDER SLAB WORK
Address ROUGH PLUMBING
City Tel.No. GAS PIPING
1 HEREBY.ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND:STATE GAS VENT
THATTHE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING. .HOT WATER HEATER
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES
REQUIRED BY LOS ANGELES COUNTY AND STATE OF:CALIFORNIA OR THAT I AM THE GAS TEST
LEGAL OWNER OF,AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL -
PROPERTY. UTILITY CO,'NOT.IFIED
SIGNATURE
OF PERMITTEE Vv FINAL �
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION• <1
cK. M.O. CASH
5 .2 a'rZuUL 12 5 0 7.540;
READY POR .FNAI INSPECTM0 . ®�
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