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APPLICATION FOR PLUMBING PERMI
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER p
BUILDING AND SAFETY DIVISION f
ILDINGa 6 w e7-JOHN A LAMBIE COUNTY ENGINEERDRESS a A1C .JCOLEMAN W JENKINS SUP T OF BUILDING CALITY 7E- 1W PL Ec/ T y
FOR APPLICANT TO FILL IN (PR NT OTYPE) IIAIOSSSST
NUMBER FIXTURE OR ITEM EACH FEE An
OWNER
WATER CLOSET 1 50 MAIL
BATH TUB 1 50 ADDRESS
SHOWER 1 50 CITY TEL NO l
LAVATORY 1 50 CONTRACTOR yPQ0,A11Cs
SINK 1 50 ADDRESS 113 S� 114q9 1(I .z,4-/117`
DISHWASHER 151 CITY 14) f��� TEL NO �a9a
CLOTHES WASHER 1 50 STATELICENSE NO p�Q�cX�� CLASS(—LIC k �J�j
SWIMMING POOL RECEPTOR 1 50 DISTRICT NO GRO!I P ZONE PRO S BY
LAWN SPRINKLER SYSTEM 2 00 V r Q. C)
c 7
WATER HEATER 1 50 INDUSTRIALWASTE APPROVAL
/ O
GAS SYSTEM OUTLETS 1 50 IN PECTI RE RD
OUTLETS OVER /� V
(/ ul
30
5 PER SYSTEM IL
Z
Plan check fee 25,% of above See reverse
PLUMBING PERMIT ISSUING FEE 8 2 00
TOTAL FEF 3O
APPROVALS DATE INSPECTOR S SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
GAS VENT
City lei No
HOT WATER HEATER
LREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
ATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST
NG
REBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED
ED AS REQUIRED BY LOSANGELES COUNTY AND STATE OF
RNIA OR THAT 1 AM THE LEGAL OWNER OF AND INTEND TO IN ABOVE DESCRIBED RESIDENTIAL PROPS r FINALi JACK R ALLEN SUP RVISING HANICAL ENG R
PERMIT VALIDATION cK o CASH
PLAN CIIE VALIDATION CK M O CASH
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