HomeMy Public PortalAbout9111 BROADWAY_Plumbing__ F
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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OFCOUNTY ENGINEER ADDRESS �p
BUILDING ANDD SAFETY DIVISION RU
JOHN A. LAMBIE, COUNTY EN GINE ER\ '
COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN PR NT OR TYPE) NEAREST
CROSS ST. /V e/4111 ¢
NUMBER FIXTURE OR ITEM EACH FEE
WATER CLOSET I50 OWNER CD
BATHTUB 1.50 ADDRESS
SHOWER 1.50 CITY ���� TEL. NO. 9/
LAVATORY 1.50 CONTRACTOR
SINK 1.50 ADDRESS
DISHWASHER 1.50 CITY 7 L/T TEL. NO. / 7n7
CLOTHES WASHER L50 STATE LIC
LICENSE NO. // CLASS
SWIMMING POOL RECEPTOR 1.50 DISTRICT NO. GROU ZONE CE65E
08 LAWN SPRINKLER SYSTEM 2.00 71,, CD
WATER HEATER .1159 INDUSTRIAL U
WASTE APPROVAL 'L -
GAS SYSTEM OUTLETS 1.50 INSPECTION RELOAD 0F-
OUTLETSOVER U
5 PER SYSTEM .30 a
N
Z
Plan check fee 25-1 of above. See reverse..
PLUMBING PEHART ISSUING FEF. $
TOTAL FEE
APPROVALS DATE INSPECTOR'S SIGNATURE
Plan Check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
GAS VENT
0.111 Tel. I\U. HOT WATER HEATER
1 HEREBY ACKNOWLEDGE THAT 1 HAVE REAO THIS APPLICATION
ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST
PLUMBING.
1 HEREBY CERTIFY THAT I AM PROPERLYTI
REGISTERED AND/OR UTILITY CO. NOTIFIED
LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE,OF -
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO �J
RESIDE IN,THE ABOVE DESCRIBED RESIDENTIAL P E v. FINAL
SIGNATURE JACK R. ALLEN, SUPERVISING CM/NICAL ENG R.
OF PERMITTEE
PERMIT VALIDATION cK. M.o. CASH
PLAN CHECK VALIDATION CK. M.0. CASH
V
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