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76 A 667'P CE 817 8/68
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING J/
BUILDING AND SAFETY DIVISION ADDRESS s �j�/�j'/ ,T
JOHN A. LAMBIE. COUNTY ENGINEER
COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY L
FOR APPLICANT TO FILL IN (PR NT OR TYPE) NEAREST
NUMBER FIXTURE OR ITEM EACH FEE cross sr.
WATER CLOSET 1.50 OWNERMAIL
BATH TUB 1.50 ADDRESS /spa
SHOWER 1.50 CITY TEL. NO.
LAVATORY 1.50 CONTRACTOR
SINK 1.50 ADDRESS
DISHWASHER 1.50 CITY��G /�Q�E �7 TEL. NOZt?6_Z�9
CLOTHES WASHER 1.50 ATE LIC
LICENSE NO. —.23-S I/ CLASS � 76
SWIMMING POOL RECEPTOR 1.50 DISTRICT NO.-,D, GROUP NE SSED BY
LAWN SPRINKLER SYSTEM 2.00 O
WATER HEATER 1.50 INDUSTRIAL C..')WASTE APPROVAL Z
O
GAS SYSTEM OUTLETS 1.50 7 INSPECTION RECORD I.-
OUTLETS OVER .3G a
5 PER SYSTEM
Z
Plan check fee 2S% of above. See reverse.
PLUMBING PERMIT ISSUING FEE 8 00
TOTAL FETE
APPROVALS DATE INSPECTOR'S SIGNATURE
Plan check applicant r s^ UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
GAS VENT
City Tel. No. HOT WATER HEATER
I HEREBY ACKNOWLEDGE THAT I 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.
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED
LICENSED AS REQUIRED BY LOS ANGE S C NTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGA OW OF,AND INTEND TO
RESIDE IN,THE ABOVE DESCRIBED R DEN L PROP Y. FINAL
SIGNATURE ' JACK R. ALLEN, SUPERVISIN CH ANIS AL EIN G'R.
OF PERMITTEE
PERMIT VALIDATIONcK. M.o. CASH.
PLAN CHECK VALIDATION K M. CASH
;�. 1 9 7 yc---' AUG 1 8 U 4.75-
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