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APPLICATION FOR'"PLUMBING` PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER.
BUILDING AND SAFETY DIVISION eulLOwc
MAKE CHECKS PAYABLE TO:, ,�A ADDRESS -1 CQ
HARVEY T. BRANDT, COUNTY ENGINEER .
LOCALITY _ PL
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. FOR APPLICANT TFILL IN (PRINT OR TYPE) NEAREST �. C
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NUMBER FIXTURE OR ITEM @ FEE CROSS,ST.
.a OWNER
WATER CLOSET 1'75 MAIL o ' O
*-
BATH TUB 1.75 ADDRESS S�. Au
SHOWER 1,75 CITY TEL'NO' 491,-1391`1
LAVATORY 1.75 CONTRACTOR F••/SJ-t5 ,
SINK 1.75 [� ADDRESS _ 1� 60S.
- 'DISHWASHER 1.75 Cm c - TEL. N0.33
CLOTHES.WASHER. 1.75 STATE LIC,.
LICENSE NO. CLASS
SWIMMING POOL RECEPTOR. 1.75 -
DISTRIC NO. GROUP ZONE �EQCESSED BY
LAWN SPRINKLER SYSTEM— 1.75 ✓ C••7 (/
4 ,
WATER HEATER1.75 .J INDUSTRIAL
,WASTE APPROVAL
GAS SYSTEM OUTLETS 1.75 d
INSPECTION RECORD U
OUTLETS OVER - -
5 PER SYSTEM .30 •_, �. CD
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Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEE $ 3 Da
TOTAL FEE ,JO
APPROVALS DATE 1111FC TOR'ss1,NA TURe -
Plan Check applicant UNDER SLAB WORK
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Name Q °ck . ROUGH PLUMBING_WT
Address 1q. S' - GAS PIPINGcvno I
City A••rl Tel. No.- '(,7 .Aq GAS VENT -
`1 HOT WATER HEATER fk
HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS LAWS REGULATING
PLUMBING. GAS TEST �
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO:NOTIFIED
LICENSED AS REDD I RED BY LOS ANGELES COUNTY AND STATE OF _
CALIFORNIA OR THAT AM THE.LEGAL OWNER OF, AND INTEND TO
RESIDE IN THE ABOVE DES C BED RESIDE IAL PROPERTY. FINAL �•'
SIGNATURE
D
OF PE RM)TT;EE V F �•--��1� -
PERMIT VALIDATION .0. CASH
PLAN CHECK VALIDATION CK. M.O. CASH '
/� 9 29 . 5. .o 1 3.5 0 nsu