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APPLICATION F PLUM G PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUN'T'Y ENGINEER
BUILDING AND SAFETY DIVISION
MAKE'CHECKS PAYABLE 2O: BUILDING 4
ADDRESS 3 Yt�
HARVEY T. BRANDT, COUNTY ENGINEER LOCAUTY
FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST
NUMBER FIXTURE OR ITEM 0 FEE CROSS ST
WATER CROS 2.00 OWNER 4at",eS 6. ;;e t1I t
MAIL
' BATH TUB 2.00 ADPR(:SS d a Y�
SHOWER 2.60 CITYlj�t TEL.•NO s`t�7 f.21
LAVATORY 2.00 .� to CONTRACTOR
SINK 2.00 ADDRESS
DISHWASHER 2.00 CITY TEL NO.
CLOTHES WASHER 2.00 STATE LIC
410ENSE NO. CLASS
SWIMMING POOL RECEPTOR 2,00
DI CT NO P ONE PR E38E BY
LAWN SPRINKLER SYSTEM 2.00
r WATER HEATER 2.00 WASTE APPROVAL
GAS SYSTEM OUTLETS x.00 D INSPECTION RECORD
OUTLE-T9 OVER
5 PER SYSTEM •SO
O
W
Z
Plan cheek fee So* Reverse
PLUMBING PERMIT ISSUING FEE 8 S 00
TOTAL FEE
Plen Check BppllCent� APPROVALS BATE IXSF[CTO R' •1GNATU A[
UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
City Tel. No. t;As VENT
I HEREBY ACKNOWLEDGE THAT 1 HAVE REAP .THIS APPLICATION HOT WATER HEATER
AND STATE THAT THE ABOVE IS CORRECT AND AGR[[ TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDI NANCU AMD STAT[ LAWS REGULATING
PLUMBING. GAS TEST
I HEREBY CERTIFY THAT 1 AM -PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED
LICENSED AB R[dUTAED BY LOS ANG EL[G COUNTY r,AND S-TATE OF
CALIFORNIA OR TKAT I AM TH[ LEGAL OWNER OF, Z INTEND TD
RESIDE IN TH[ASOVE D CRISEn RpIDENTIAL Ro�[RTY. FINAL
SIONATU RE
OF PERMIT=— GWV
RM T,VALIDATION CAIH
PLAN CHECK VALIDATION CK. M.O. CASH
021 4 e 1 1.7-5 aha