HomeMy Public PortalAbout9828 BROADWAY_Plumbing__ 76,A,S6]7 CE 817 8/68 � �' C
-APPLICATION FOR . PLUMBING. PERMIT
COtTNTY OF LOS ANGELES
DEPARTMENT
BUI]
BUILDING AND SAFIETYYDNISIONR !g
LLDE
G
JOHN A. LAMSIE. COUNTY ENGINEER
COLEMAN W. JENKINS. SUPT. OF BUILDING
FOR APPLICANT TO FILL IN (PR NT OR TYPE) NEARE
NUMBED FIXTURE OR ITEM EACH FEE
Jf� OWNER
WATER CLOSET 1.50 (J MAIL
BATH TUB 1.50 ADDRESS
SHOWER 1,50 CITY 'gtTEL. N0,1,$777, d00
LAVATORY L50 I CONTRACTOR
SINK 1.50 s ADDRESS _614CCZ4,,, -e.
DISHWASHER 1.50 CITY TEL. NO.
CLOTHES WASHER 1,50 STATE LIC
LICENSE NO. CLASS
SWIMMING POOL,RECEPTOR PT OR LSU DIBTRIR NO. GROUP NE ESBED BY
LAWN SPRINKLER SYSTEM 2.00 �� �' _ ` d
O
WATER HEATER 1.50INDUSTRLIL U
WASTE APPROVAL o
GAS SYST F.W1 OUTLETS 1.50 I S INSPECTION RECORD H
OUTLETS OVER - .30 d
5 PER SYSTEM
H
Z
Plan check fee tin of above. See reverse.
PLUMBING PlEfNIT ISSTIING FEE 8 2 00
TOTAL FEE
APPROVALS DATE II ECTOR5 SIGNATURE
Plan chert: appli aat UNDER SLAB WORK
Nance ROUGH PLUMBING
Ad(ITess GAS PIPING
GAS VENT
City Tel. No.
HOT WATER HEATER
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ 'HISGRE APPLICATION
AND STATE THAT THE ORDINANCES
1$ CORRECT AND AGREE E COMPLY PLUMBING FIXTURES y/
WITH ALL COUNTY ORDINANCES AHO STATE LAWS REGULATING GAS TEST
PLUMBING.
HEREBY CERTIFY' THAT 1 AM PROPERLY REGISTERED ANO/Op UTILITY CO. NOTIFIED
LICENSED AS REQUIRED M LOS ANGELES COUNT
YATE OF
CALIFORNIA OR THAT AM TN LEGAL OWNER ONO TORESIDE IN, THE ABOVE OESCRI DREIDENTIALPRFINAL
SIGNATURE ,L JACK R. ALLEN, SUPERVISING MECHANICALEN G'47
OF PERMITT
PERMIT VALIDATION CK. M.O CASH
PLAN CHECK VALIDATION CK. M;V CASH
k-AA,r, 3 u 6 0 DE i� 2 5 D 9.50