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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS 1919 Agnes
COLEMAN W JENKINS SUP T OF BUILDING LOCALITY Temple Cloy J
FOR APPLICANT TO FILL IN(PR NT OR TYPE) NEAREST
CROSS ST lt/a o
NUMBER FIXTURE OR ITEM EACH FEE
OWNER To Tombrello
WATER CLOSET 1 50
I KAIL
BATH TUB 1 so d ADDRESS 1919 Agnes
SHOWER 1 so CITY Te=le City TEL NO 2
LAVATORY 150 CONTRACTOR Pacific Installers
SINK 1 50 ADDRESS 10920 E. Grand
DISHWASHER 1 50 1 Ciry Temple City TEL No 442 7070
SATE LIC
CLOTHES WASHER 1 50 LICENSE NO 211898 CLASS C 20°`x_
SWIMMING POOL RECEPTOR 1 50 DISTRICT NO GROUP ZONE PROCESSED BY
LAWN SPRINKLER SYSTEM 2 00 I ��� �� �!/'I' L! u
WATER HEATER 1 5o C) INDUSTRIAL
WASTE APPROVAL a /r
GAS SYSTEM OUTLETS 1 50 INSPECTION RE5pp O
OUTLETS OVER 30 7/,/
5 PER SYSTEM �( N W
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Plan check fee 2S% of above See reverse
PLUMBING PERMIT ISSUING FEE S 2 00
I
I OTAI FEE I 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
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST
PLUMBING
P
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF AND INTEND TO
RESIDE IN THE ABOVE DEE&CCJWED RES NTIAL PR PERTY FINAL
SIGNATURE I JACK R ALLEN SUPERVI51 CHANICAL ENG R
OF PERMITTEE �L
PERMIT VALIDATIO cK M o CASH
PLAN CHECK VALIDATION CK M o CASH
9' JAN21 s D 3.50- E'l
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