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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISIONxonDIIIS E(�/ ✓F•
.JOHN A. LAMBIE. COUNTY ENGINEER
RE
COLEMAN W. JEN KINS. SUPT. OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN PR NT OR TYPE) NEAREST
CROSS ST. �lN/rR zusA I�J�
NUMBER FIXTURE OR ITEM EACH FEE OWNER T
WATER CLOSET 1.50
MAIL t
BATH TUB 1.50 ADDRESS �a 0414Z.4
SHOWER 1.50 CITY 7EIYA4 / 7- TEL. NO.
LAVATORY 1.50 CONTRACTOR IQ A/C
SINK 1. —ISADDRESS
DISHWASHER 1.50 CITY TEL. NO.
CLOTHES WASHER 1.50 STATE LIC
LICENSE NO. CLASS
SWIMMING POOL RECEPTOR 1.50 DISTRICT NO GROUP ZONE ROCE6 V
LAWN SPRINKLER SYSTEM
WATER HEATER 1.50 TE APPROVAL - 3
I GAS SYSTEM OUTLETS 1.50 INSPECTION RECORD 8
OUTLETS OVER 30 - O
5 PER SYSTE&I
W
1
N
Z
Plan check fee 25% of above. See reverse. -
PLUMBING PERMIT ISSUING FEE .$ 00
TOTAL FEE APPROVALS DATE INSPECTOR'S SIGNATURE
PI30 check applicant UNDER SLAB WORK q
Name ROUGH PLUMBING u'y
Address GAS PIPING
GAS VENT
City, Tel. No. HOT WATER HEATER
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
< AND STATE THAT THE ABOVE IB CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST
PLUMBING.
I HEREBY CERTIFY THAT 1 AM oPROPE LY REGISTERED ANO/OR UTILITY CO. NOTIFIED
LICENSED AS REQUIRED BY LOS ANGEL COUNTY AIIO STATE OF
CALIFORNIA OR THAT 1 AM TNC CGA N[R OF,A INTEND TO
CA IOC IM, THE ABOVE I AM T E T AL PROP Y. FINAL J
SIGNATURE JACK R. ALLEN, SUPERVISING MECH ANIP.S
OF PERMITTEE PERMIT VALIDATION CK. M.o
PLAN CHECK VALIDATION CK. M.D. CASH
Liuo 4 1 4 3—� J,111'4 127 5 D 6.5 0^1