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APPLICATION FOR PLUMB NG PE IT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION 1UII.DD1a
JOHN A. LAMBIE. COUNTY ENGIN[[R ADDIFJM
COLEMAN W. JENKINS. SuP'T. OF BUILDING
FOR APPLICAlfT TO FILL IN Qos
ST.
NUMBRR FI R[GR mzm [ACH FEK
OA]m
WATER CLOSET 3 O O
xAn Azb
RATH TUB O ADDIM
SHOAL S u crr7r TEL NO.
LAVATORYCORTRACTO)t r
Am O ADD=S
IS�HpACCfT TER., NO. 3—QQ
L/tUl�l TUB �� STATE k[lLIC
LICENBE NO. — CLASS C-34
CWTHIO WAS I soDI RICT NO.. R
WATER EIRATER I w
OAS sYSTEIc _OUTIETB I-sa 0 ASTE�PP OVAL
OUTLM OVER i PER s7srEK .30Mf=dN RECORD
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APPROVALS DATE IH cTOR•s YIGNATUR[
PERMIT s 2 ,00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL REE 'PAZ PIPING
I HXFMWY ACKN01YL4D0[ T"T I HAV[ MLA15 THI• U-TN �8 VENT
W
AND CTAT[ THAT TH[._A10V[ 19 CO RRLCT AND AGRQ TO COMPLY
TTH ALL COUNTY ORDINANC" AND 8rAT[ LAWS WGULATIN•
PLUMSINO. H6T WATER HEA'T'ER
1 HKXY CXFFT1FT THAT I AM F"OPX*LY R[019T[R[D AND/OR PLUMBING FIXTURES
Li CIN' As PWQuiR.L .T LO* AN01Lis COUNTY AND .TAT[ OF GAS TEST
CAT..IFORNI.� OR THAT 1 Ali THE L[OAL OW}Ql� OF,AND INTQID Tb
Pt"IDc 1N,TH[ RI.IDCMTIAL PROr[1fTY. UTILITY CO. NOTIFIED
MIGNATUR[
OF FYRMITT[[
Il p/416-or IV
FINAL
C JACK R. ALLEN
.0.o' cASH SUPERVISING MECHANICAL ENG'R.
215 4 4% JW10 5. D 18.25- 9
76A E47—CE 817 8/68
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APPLICATION FOR PLUM SIG PETRMIT
COUNTY OF LOS ANGELES 6 -5-
DEPARTMENT OF COUNTY ENGINEEE
BUILDING AND SAFETY DIVISION I1UM A)i
JOHN A. LAMBIE, COUNTY ENGINEER
COLEMAN W. JENKINS. SUPT. OF BUILDING IOCAI.ICT
FOR APPLICANT TO FILL IN CPR IfT Olt TYPE) CROW NT.NUMBER FIXTURQ OR ITEM EACH FHE
RATER CLOSET 1.50 Owxn
X&M
BATH TUB 1.50 r
SHOWER 1.50aTy-r �" •
LAVATORY 1.5 0 CONTRACTOR
SINS 1.50 ADDEM
DISHWASHER 1.50 CITY TEL NO.
CLOTHES WASHER 1.50 STAT[ LIC
LICENOR NO. CLASS
SWDMING POOL RECEPTOR 1.50 DISTRICT Nb_ GROUP [ [SSED BY
LAWN SPRIIIK.LER SYSTEM 2.00 SOU _L � O
WATER HEATER 1.50 WASTE
APPROve GZ�
O
f GAS SYSTEM OUTLETS 1.50 / d DIMPEMON RECOI9D
OUTLETS OVER 30
5 PER SYSTEM
Cn
Z
Plan check fee 2.5% of above. See reverse.
PLUMBING PERMIT ISSUING FEE S 2 00
TOTAL FEE
APPROVALS DATE INSP[GTOR'S■IGNATU Rt
Plan check applicant UNDER BLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
GAS VENT
City Tel. NO. HOT WATER HEATER
IHSRiSY ACKHOWLSOO[ tNAY I HAVE RSALI
D THIS AITCATION
ACID STAT[ THAT THE ABOVE IS coRl<(.T AND ASRQ TO COMPLY
ITPLUMBING FIXTURES
WHALL COUNTY ORDIMAMClH
J AD STATE LAW S REGULATING GATEST
PLU MSINO.
1 Hf.RS7Y CSATIFY THAT I AM PROPERLY REGISTERED AHD/OR UTILITY CO. NOTIFIED
LICENSEDAS REq UIRm ■Y LOO ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE O OF,AND INTIb1D TO
RESIDE IN.THE ASOVE DKSC/tl■E IDS L PROPERTY. FINAL
9I13NATURII JACK R. ALLEN, fUPERV SING MECH ANI CA G'R.
OF .".ITT..
PERMrT VALIDA'T'ION c K.' M.O. CAD
PLAN CHECK VALIDATION CK. M.O. CADH
ar_ o z 9cl- 7 5 o 5-.0 0—