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APPLICATION POFD PLUME31 SIG PERRL
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING 1411
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
COLEMAN W JENKINS SUP T OF BUILDING LOCALITY /
FOR APPLICANT TO FILL IN(PR NT OR TYPE) CROSSSST OL ,
NUMBER FIXTURE OR ITEM EACH FEE
lWATER CLOSET 1 so OWNER
MAIL
BATH TUB 1 So ADDRESS
SHOWER 1 50 CITY TEL NO
It LAVATORY 1 50 CONTRACTOR >
SINK) 1 50 I ADDRESS <1!72 _3 e-WeZ1A_P1rfi
DISHWASHER 1 50 CITY �' TEL
4
CLOTHES+WASHER 150 STATELIC J
LICENSE NO 5� 7// CLASS
SWIMMING POOL RECEPTOR 1 50 DISTRICT N GR ZO E{ PR BY
LAWN SPRINKLER SYSTEM 2 00 V V / a
WATER HEATER 1 SO rAb INDUSTRIAL I t r
WASTE APPROVAL Z
GAS SYSTEM OUTLETS 1 50 C
INSPECTION RECORD `
OUTLETS OVER LL
5 PER SYSTEM 30 v
_ � Z
s
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Plan check fee 21)% of above See reverse
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PLUMBING PERMIT ISSUINC F1,F 8 00 -�
10TAL FEE `
APPROVALS DATE IN#FCTOR SIGNATURE
Plan check npplicant 1J UNDER SLAB WORK -7i(71-77t
t'
Name ROUGH PLUMBING
Address GAS PIPING
GAS VENT
CI[) Tel No HOT WATER HEATER
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION a
ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
GAS TEST
PLUMBING q� 2�
I HEREBY CERTIFY THAT 2PR Y REGISTERED AND/OR UTILITY CO NOTIFIED
Ile
LICENSED AS REQUIRED BY CO TY AND STATE OFCALIFORNIA OR THAT I AM OF AND INTEND TORESIDE IN THE ABOVE DEGCRPROPE FINAL'
_U'
SIGNATURE JACK R ALLEN SUPER V I51HANICAL ENG R
OF PERMITTEE
PERMIT.VALIDATION Qc K M o CASH
PLAN CHECK VALIDATION M o ASH
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