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7GA667 CE#617 10 67
APPLICATION FOR PLUMBI G PERM
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS L11
COLEMAN W JENKINS SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN PR NT OR TYPE) NEAREST M
CROSS Si
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET 1 50
MAIL
BATH TUB 1 50 ADDRESS93D4
SHOWER 1 50 CITY TEL NO
LAVATORY 1 50 CONTRACTOR
SINK 1 50 ADDRESS ��ia
DISHWASHER 150 CITY Wed
VPS TEL NO 46 4
CLOTHES WASHER 1 50 STATE LIC
LICENSE NO CLASS
SWIMMING POOL RECEPTOR 1 50
DISTRICT NO feRQUP Z NE PRO S BY
LAWN SPRINKLER SYSTEM 2 00 V �(/(-� 2
O
WATER HEATER 1 50 INDUSTRIAL rJ
WASTE APPROVAL
CD
GAS SYSTEM OUTLETS 1 50 INSPECTION RECORD
OUTLETS OVER "-
5 PER SYSTEM 30 A4.4d
Plan check fee 25% of above See reverse
PLUMBING PERMIT ISSUING FEE 8 2 00
TOTAL FEE
APPROVALS TE INSP TOR S SIGNATURE
Plan check applicant UNDER SLAB WORI,(
Name ROUGH PLUMBING
Address GAS PIPING
GAS VENT
City Tel No
HOT WATER HEATER
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 GAS TEST ,b~
PLUMBING
INEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE L L OWNER OF AND INTEND TO '�
RESIDE IN THE ABO ESCRIBEDuar
RTY
FINAL Q�
SIGNATURE JACK R ALLEN SUPERVi51N CHANICAL ENG R
OF PERMITTEE
PERMIT VALIDATION CK M o CASH
PLAN CHECK VALIDATION CK M o c SH
L rib 4 3 1-,o -�t? 7 5 D 5 � "S
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