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76A667 (rE 817) 5/73
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES - T R Y I
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION F--
LDING
MAKE CHECKS PAYABLE TO DRESS 4846 Agnea v� 1
HARVEY T BRANDT COUNTY ENGINEER ALITY TeMPU ItFOR APPLICANT TO FILL IN (PRINT OR TYPE) ARESTOSS ST
NUMBER FIXTURE OR ITEM @ FEE
WATER CLOSET 1 75 OWNER Rosemead Const D=er
MAIL
BATH TUB 1 75 ADDRESS 2020 Barnett way
SHOWER 1 75 CITY L• A• TEL NO
LAVATORY 1 75 CONTRACTOR Owen Bros Plumbing, Inc
SINK ` 1 75 ADDRESS
4265 N- Baldwin bre-
DISHWASHER 1 75 CITY El Monte TEL NO 44-1,0076'
CLOTHES WASHER 1 75 STATE LIC
CENSE NO `Z31 CLASS (�' 6-20
SWIMMING POOL RECEPTOR 1 75 L
DISTRICT NO rROUPIgNEI,--kROCESS BY
LAWN SPRINKLER SYSTEM 1 75 �
WATER HEATER 1 75 INDUSTRIAL I
WASTE APPROVAL
GAS SYSTEM OUTLETS 1 75 I INSPECTION RECORD V
OUTLETS OVER F
5 PER SYSTEM 30 l ! O
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Plan check fee S R s
PLUMBING PERMIT ISSUING FEE $ 3 00
t I
TOTAL FEE
APPROVALS DATE o
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING f'
City Tel NO GAS VENT y
f
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER
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AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES t� 1
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING GAS TEST tr
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED }
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO
RESIDE IN THE ABOVE DE IS ESIDENTIAL PROPERTY FINAL
SIGNATU RE
OF PERMITTEE
PERMIT VALIDATION ®rKM O CASH
PLAN CHECK VALIDATION CK M 0 CASH
8 1 9 r RUG 1 5 1) 6 5 Q e-la
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