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APPLICATION FOR PLUMBING PER IT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN (PR NT OR TYPE) NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE
OWNER -11"k)AX 0E
WATER CLOSET 1.50 MAIL
BATH TUB 1.50 ADDRESS
SHOWER1.50 CITY TEL. NO.
LAVATORY .50 CONTRACTOR
SINK 1.50 ADDRESS
DISHWASHER 1.50 CITY TEL. NO.
CLOTHES WASHER 1.50 STATE LIC
LICENSE NO. CLASS
SWIMMING POOL RECEPTOR 1.50 DISTRICT NO. GROUP ZONE PROCESSED BY
LAWN SPRINKLER SYSTEM 2.00 C.
WATER HEATER 1.50 INDUSTRIAL r
WASTE APPROVAL
/ GAS SYSTEM OUTLETS 1.50 INSPECTION RECORD g
OUTLETS OVER 30
5 PER SYSTEM
Lu
Vf
Plan check fee 25% of above. See reverse.
PLUMBING PERMIT ISSUING FEE $ 2 00
TOTAL FEE
APPROVALS DATE INSPECTOR'S SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
GAS VENT
City. - Tel. No. HOT WATER HEATER
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES f
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST ;d
PLUMBING.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO
.RESIDE IN,THE ABOVE CRRII EEDD�nQRES PROPERTY. FINAL
SIGNATURE �*' V JACK R. ALLEN, SU ERV SING MECHANICA
OF PERMITTEE
PERMIT VALIDATION CK. M.O. CASH
CHECK PLAN
C CK VALIDATION CK. M.O. CASH
! Af,,8.z21DEC 2.3 5 0 3.50-