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APPLICATION FOR PLU BIN PER
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING ADDRESS .� T
JOHN A. LAMBIE, COUNTY ENGINEER c
COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY ��'M�� �/• ti
FOR APPLICANT TO FILL IN (PR NT OR TYPE) CROSNEARSSST.
NUMBER FIXTURE OR ITEM EACH FEE rj 9 �
WATER CLOSET 1.50 MAILOWNER IVV�� r
BATH TUB 1.50 C/ ADDRESS C5-7;e) W .. . �1
SHOWER 1.50 ' CITY i TEL. NO. — Zy,
LAVATORY 1.50 j CONTRACTOR •V LVl_
SINK 1.50 ADDRESS W .
DISHWASHER 1.50 CITY JIMAPM ; TEL. NO. g2�,
CLOTHES WASHER 1.50 STATE LIC
LICENSE NO. CLASS
SWIMMING POOL RECEPTOR 1.50
DISTRICT NO. GROUP ZONE PROCESSED BY
LAWN SPRINKLER SYSTEM 2.00 +e, f a
CD
WATER HEATER 1.50
INDUSTRIAL v
WASTE APPROVAL Z
GAS SYSTEM OUTLETS 1.50 INSPECTION RECORD
IOUTLETSOVER
c�
5 PER SYSTEM •30 a_
C/)
Z
Plan check fee 27)% of above. See reverse.
PLUMBING PERMIT ISSUING FEE S 2 00
TOTAL FETE (j ��
APPROVALS DATE I ECTO •s IGNATURE
Plan checks' applicant UNDER SLAB WORK v _
Name Vll Iwl ` ROUGH PLUMBING
Address 5-7 GAS PIPING
CSI GAS VENT ..
Citq el.-
No. , ` HOT WATER HEATER
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE'TO COMPLY PLUMBING FIXTURES
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST
PLUMBING.
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 I THE LEGAL OWNER OF AND INTEND TO
RESIDE IN,THE ABOVE C IB SIDEN L OP v. FINAL Z
SIGNATURE JACK R. ALLEN, SUPERVISING ME ANICAL EN G'R.
OF PERMITTEE
PERMIT VALIDATION c KKM.O. CASH,
PLAN CHECK VALIDATION CK. `M.Ou CASH
.7 4 8 3c-- NOV 5 3 015w
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