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76 A 667—CE 817 8/68
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
COLEMAN W. JENKINS. SUPT OF BUILDING LOCALITY )
FOR APPLICANT TO FILL IN (PR NT OR TYPE) NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
` WATER CLOSET 1.50
BATH TUB 1.50 ADDRESS
SHOWER 1.50 CITY TEL. NO. W` ,
LAVATORY 1.50 CONTRACTOR J, ^�
SINK 1.50 ADDRESS
DISHWASHER 1.50 CITY TEL. NO.
CLOTHES WASHER 1.50 STATE LIC
LICENSE NO. CLASS -
SWIMI\1ING POOL RECEPTOR 1.50 DISTRICT NO GRO _ ZOINLER S B
LAWN SPRINKLER SYSTEM 2.000 C)
r V
WATER HEATER 1.50 INDUSTRIAL
WASTE APPROVAL
GAS SYSTEM OUTLETS INSPECTION RECORD v
Lu
OUTLETS OVER d
5 PER SYSTEM 30 Z
1 -
Plan check fee 25% of above. See reverse.
PI_IJMBING PERMIT ISSUING FI-"E S 00
TOTAL FEE
APPROVALS DATE INSPECTOR'S SIGNATURE
Plan Check al)pli(-,Lnt UNDER SLAB WORK
Name ' ROUGH PLUMBING
Address GAS PIPING
GAS VENT
City Tel. 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
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST
PLUMBING
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 T ,� OWNER •AND INTEND TO '
RESIDE IN,THE ABOVE ES BED R EN I PROPERTY. .!
FINAL
SIGNATURE ,. JACK R. ALLEN, SUPERVISING MECHANICAL
OF PERMITTEE
PERMIT VALIDATION CK. M.O. CASH
PLAN CHECK VAL DATION CK m.6. CASH
_ �t JIUL 16 75 D
76A667 -'CES17 5/70
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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LJIMBIE, COUNTY ENGINEER ADDRESS (.� ✓
COLEMAN W:JrNKINS. SUPT. OF BUILDING LOCALITY A C/A
FOR APPLICANT TO FILL IN (PR NT OR TYPE) NEAREST J��O )/
CROSS ST. '
NUMBER FIXTURE OR ITEM EACH FEE OWNER l �✓��
WATER CLOSET 1.50MAIL
BATH TUB 1.50 ADDRESS
SHOWER 1.50 CITY G Pi T TEL. NO. �V
LAVATORY 1.50 1,529
CO RACTOR S / I 3.r4
SINK 1.50 ADDRESSf/f/f?
DISHWASHER 1.50 CITY TEL. NO.
CLOTHES WASHER 1.50 STATE LIC
LICENSE NO, CLASS
SWIMMING POOL RECEPTOR 1.50 DISTRICT NO GR P ZSEPR E D BY
LAWN SPRINKLER SYSTEM 2.00 �_�
WATER HEATER 1.50 INDUSTRIAL
WASTE APPROVAL
GAS SYSTEM OUTLETS 1.50 INSPECTION RECORD u
OUTLETS OVER n Q
5 PER SYSTEM .30 �Gr7���S/T�, it e)! r��D Y ���D Y /It.. ®_
Lu
d.
H
z
Plan check fee 25% of above. See reverse.
PLUMBING PERMIT ISSUING FEE S 2 00
TOTAL FEE APPROVALS DATE INS PE TOR'S SI NATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING ;W T 1
GAS VENT
City Tel. No. HOT WATER HEATER
I HEREBY ACKNOWLEDGE THAT 1 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.
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 T EGAL OWNER OF,AND INTEND TO
RESIDE IN, THE ABOVE;7 BED ESIDEN ROPE RTY. FINAL
SIGNATURE % JACK R. ALLEN, SUPERVISING MECHANICA R.
OF PERMITVEF
PERMIT VALIDATION CK. M.O ----o P sH
PLAN CHECK VALIDATION CK. M.O. CASH
f � 0 8 8 9c--' JL'NN1 6 5 D 6.50—