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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO: ADDRESS Q (� � �E
HARVEY T. BRANDT, COUNTY ENGINEER ADDRESS
LOCALITY LE 1
FOR APPLICANT TO FILL IN (PRINT OR TY PEI NEAREST f
CROSS ST. Ec
NUMBER FIXTURE OR ITEM @ FEE
2.00 OWNERajtEt yC
WATER CLOSET MAIL
BATH TUB 2.00 ADDRESS
SHOWER 2.00 CITY TEL. N0. 02 p2
LAVATORY 2.00 CONTRACTOR
SINK 2.00 ADDRESS
DISHWASHER 2.00 CITY �• EL. NO.
'el IA/
CLOTHES WASHER 2.00 STATE V v LIC
LICENSE NO. CLASS
SWIMMING POOL RECEPTOR 2.00•
DISTRICT NO.GROUP ZONE I PROCESSED BY
LAWN SPRINKLER SYSTEM 2.000� �-
a
WATER HEATER 2.00 INDUSTRIAL
WASTE APPROVAL
GAS SYSTEM OUTLETS INSPECTION RECORD a
OUTLETS OVER 30 U
5 PER SYSTEM
O
U
W
CL
N
Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEE $
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
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 OROINANC ES AND STATE LAWS REGULATING
PLUMBING. ' GAS TEST
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED
LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF..AND INTEND TO
RESIDE IN THE ABOVE DESCRIBED RESIDEN AL Pik TY. FINAL
SI GNATU RE
OF PERMITTEE'
PERMIT VALIDATION CK. m.o. CASH
PLAN CHECK VALIDATION CK. M.O. CASH
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APPLICATION FOR PLUMBING PERM
COUNTY OF LOS ANGELES
DEPARTMENT'OF COUNTY ENGINEER NG
BUILDI
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
JOHN A. LAMBIE. COUNTY ENGINEER
COLEMAN W. JENKINS. SUPT OF BUILDING LOCALITY r
FOR APPLICANT TO FILL IN (PR NT OR TYPE) NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET 1.50
MAIL y1
BATH TUB 1.50 ADDRESS /y As
SHOWER 1.50 `� CITY ��� �� TEL. NO- -3
LAVATORY 1.50 CONTRACTOR
SINK 1.50 ADDRESS
DISHWASHER 1.50 CITY TEL. NO.
CLOTHES WASHER 1.50 STATE LIC
LICENSE NO. CLASS
SWIMMING POOL RECEPTOR 1.50 DISTRICT NO. GRO ZONZ R ES BY
LAWN SPRINKLER SYSTEM 2.00 ' — V p_
O
WATER HEATER 1.50 INDUSTRIAL U
/ WASTE APPROVAL Z
GAS SYSTEM OUTLETS 1.50 I INSPECTION RECO 2
OUTLETS OVER
U
S PER SYSTEM •30 U-1
Tn '
I Z
Plan clieck fee 25% of above. See reverse.
PLUMBING PERMIT ISSUING FEE S 2 00
1'O"I AL FEE O APPROVALS DATE INSP TOR'S SIGNATURE
Plan Check applicant UNDER SLAB WORK
;Varve � ROUGH PLUMBING
Address `A GAS PIPING
GAS VENT '
CIL}' Tel. No. 3 HOT WATER HEATER
I HEREBY ACKNOWLEDGE THA 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.
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED �^
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ,`j• _ v ! y 1,_ 4)
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO I[iG�r
RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. FINAL / a
SIGNATURE JACK R. ALLEN, SUPERVISING MECHANICAL ENG'R.
OF PERMITTEE
PERMIT VALIDATION _CK M.O. CASH
H
PLAN CHECK VALIDATION CK. M.O. CA
IH z 4 4 u� 0`12 5 5 0 1 1 ,0 0--