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APPLICATION FOR tPLUUMBYNGcPERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISIONfAADD
BUILDING MAKE CHECKS PAYABLE TO DI
DC
HARVEY T BRANDT. COUNTY ENGINEEALITY
FOR APPLICANT TO FILL IN (PRINT OR WPEIREST
SS ST
NUMBER FIXTURE OR ITEM ® FE
ER
-- -WATER CLOSET==--- -- Al-
BATH - - -- — - -- _
-_ - L
TUB RESS
SHOWER 1 75 TEL NO
74
LAVATORY 1_74 CONTRACTOR
SINK 1 75 ADDRESS /7
DISHWASHER 1 75 CITY TEL NO
CLOTHES WASHER 1 75 STATE ``�� � LIC
SWIMMING POOL RECEPTOR 1 75 LICENSE NO "goy CLASS
DIST�LCT NO GROUP NE CESS E BY
LAWN SPRINKLER SYSTEM 1 75 DUSTSgI LOC
WATER HEATER _ _ _ 1 75 �ypSTE APAF'ROVOAL •l_ 1 - - �-
GAS SYSTEM OUTLETS 1 75 INSPECTION RECORD V
OUTLETS OVER 30
5 PER SYSTEM j CD
CWl
Plan check fee See ReV.,.e
PLUMBING PERMIT ISSUING FEE $ 3 00
TOTAL FEE Q Q
APPROVALS GATE INSPECTOR a SIGNATURE
Plan check applicant UNDER SLAB WORK _ Y
Name ROUGH PLUMBING
Address GAS PIPING
City Tel NO GAS VENT /%
HOT WATER HEATER
1 HIRCeY THAT
TH ABO THAT HAVE READ THIS APPLICATION
AND STATE COUNTY
TXE DINAN IS CORRECT AND LAWS E COMELY PLUMBING FIXTURES
WITH ALL COUNTY ORDINAN AND STATE LAWS REGULATING
PLUMBING GAS TEST '
HCRCSY CERTIFY TH T I A PROPERLY REGIS E 0 AHD/OR UTILITY CO NOTIFIED V
LICENSEDAS REQUIRED LOS NOELES COUNTY STAT[ 0
CALIFORNIA OR THAT I A THE EOAL OW
XER QF A INTEND
RESIDE IN THE AOOV RI CSI L PR TY FINAL
SIGNATURE
OF PERMITT E
PERMIT VALIDATI CN M 0 CASH
PLAN CHECK VAL ION c M D CASH ,
336VJUL 9 5 0 ^ 11.0O � d