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APPLICATION FOR #LUMBING PERMIT
COUNTY- OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING /� /moi
BUILDING AND SAFETY DIVISION ADDRESS �',vZ d
JOHN A. LAMBIE. COUNTY ENGINEER
COLEMAN W. JENKINS. SUP T 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 LJ
MAIL
BATH TUB 1.50 " ADDRESS
SHOWER 1.50 CITY TEL. NO.
LAVATORY 1 50 CONTRACTOR j
SINK 1.50 ADDRESS fiz /
DISHWASHER 1.50 CITY TEL. NO. 49 7,��>
CLOTHES WASHER 1.50 STATE LIC C�
LICENSE NO CLASS
SWIMMING POOL RECEPTOR 1.50
DISTRICT NO G -P ZONE ,•P O SSED BY
LAWN SPRINKLER SYSTEM 2.00
WATER HEATER 1 50 17 S INDUSTRIAL PROVAL Q
/ GAS SYSTEM OUTLETS 1 50 S INSPECTION RECORD qj
OUTLETS OVER .30
5 PER SYSTEM
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Plan check fee 25% of above. See reverse.
PLUMBING PERMIT ISSUING FEE 8 00
TOTAL FEE
APPROVALS DATE INSPECTOR'S SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
GAS VENT
City Tel. No
HOT WATER HEATER
1 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 ----+--- - - 0
�AND/OR �UTIL'ITY'CO'NOTIFIED
--IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED -
LICENSED AS REQUIRED BY,1609 ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I M THE L AL OW R OF INTEND TO
RESIDE IN,THE ABO E S 1 BIDE N71 L P- PE Y FINAL
SIGNATURE JACK R. ALLEN, SUPERVISING MECHANICA Ei--�
OF PERMITTE f
PERMIT VALIDATION CK M o v sH
PLAN CHECK VALIDATIO CK M o AE
Leo -� 7- OCT 2 9 9 0 24,00-