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APPLICATION_ F PLUM G PERMIT
COUNTY OF.LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
BUILDING
MAKE CHECKS PAYABLE TO: JB
RESS
HARVEY T. BRANDT, COUNTY ENGINEERREAU el
FOR APPLICANT TO FILL IN (PRINT OR TYPE) REST
SS.ST.
NUMBER FIXTURE OR ITEM @ FEE WATER CLOSET2:00ERL
BATH TUB 2.00 ADDRESS
_SHOWER .2.00 CITY TEL NO.
LAVATORY 2.00 C 0 NTRAC T
c.
SINK2:00 ADORES
DISHWASHER 2.00 Tn
CLOTHES WASHER 2:00 TATE LIC
O.
SWIMMING POOL RECEPTOR 2..00 LICENSE CLASS C
DISTRICT NO.GROUP ZONE PROCESS BY
LAWN SPRINKLER SYSTE% 2.00 �+ �� j;—•zi
WATER HEAT 2.00 I'NDUSTRIAAL
WASTE APPROVAL
GAS SYSTEM OUTLETS 2.00 INSPECTION RECORD C
OUTLETS OVER .30 C.')5 PER SYSTEM od
CD
t3
W
00
- Z
Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEES 1 .3 00
TOTAL- FEE
APPROVALS DATE INSPECTOR'S SIGNATURE
Plan Check applicant f UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
City Tel. No. GAS VENT
HOT WATER HEATER A �y
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO.COMPLY PLUMBING FIXTURES
WITH ALL. 'COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. GAS TEST hl l d ILS
'
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED C (�
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM. THE LEGAL OWNER.OF, AND TEFfb.TO
RESIDE IN THE ABOVE DESCRIBED RESIDEN A• PROPE FINAL
SI GNATU RNVP
OF PER `
•PERMIT VALIDATI CK. M.O; CASH
PLAN CHECK VALIDATION CK. M.O. CASH
6 8; INn dull 10 5 0 4.7 5 AW