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APPLICATION FOR PLUMBING PERM
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDnNG �-
JOHN A. LAMBIE, COUNTY ENGINEER
COLEMAN W. JENKINS. SUPT. OF BUILDING IOCAJSTT r
FOR APPLICANT TO FILL IN R= OR TYPE XEAlZX[
CROW ST.
NUMBER FIXTURE OR ITEM EACH FEE OwXER
WATER CLDSHT 1.50
HATH TUB 1.50 ADDi J_
SHOWER 1.50 Q� A �L" TEL
LAVATORY 1.50
SINK 1.50 ADDEM
DISHWASHER 1.50 CTTT i 'p-
'y TEL R
CLOTHES WASHER 1.50 STAT[ LIC
LICENSE NO. CLASS
SWf1iMING POOL RECEPTOR 1.50 DI CT NOG 7 1 [. P ■Y
INE
LAWN SPRINKLER SYSTEM 2.00 - /Z O
WATER HEATER 1.50 ASTE OVAL x
O
GAS SYSTEM OUTLETS 1.50 12fEPECTION RECORD
OUTLETS OVER 30
5 PER SYSTEM
N
Z
Plan check fee 2-S% of above. See reverse.
PLUMBING PERMIT ISSUING FEE i 2 00
TOTAL FEE
APPROVALS DATE 1NSP[CT041'S SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
GAS VENT
City Tel. No. HOT WATER HEATER
1 HERDSY ACKNOWII�S THAT 1 Hwv[ RtAP
D THIS APLICATION
AND STATIC THAT THE MOVE 1• CORRECT AND AGREE TO COMPLY PLUMBING F-IXTURES
IT
WH ALL COUNTY ORDINAP6CSJ AND STAT[ LAWS REGULATING GAS TEBT
PLUMBING.
1 HERESY CERTIFY THAT I AM PROPERLY REGISTERED AMD/OR UTILITY CO.NOTIFIED 17
LI CETIS= AS REQUIRED ■Y LOS ANGELES COU AND STAT[ Of
CALLPORNUI OR THAT I AM THE LXA AL OW►aR AND INTtND TO
PKSIDE IN,THE ASOVE SED RESIDSNTIAL FINAL
SIGNATURE JACK R. ALLEN, SUPERVIS1N QC LAICAL ENG'R.
OF PERMITTIE
PERAUT VALIDATION CK.')M.0. CASH
PLAN CHECK VALIDATION CK. M.O. CASH
L ,,72 45.R OCT 19 5 D 3.50- W
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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES BUILDINia AND SAFETY
FOR APPLK-W TO FILL IN IPRJNT OR TYPO BUILDING
NUMBER FIXTURE OR ITEM, O FIFE A DO NESS
WATERCLOSET LO AUTY
N EARESt
BATH TUB CRoss
SHOWER
OWNS t
LAVATORY ADDRESS Q
SINK GTY TEL NO.a L g'
DISH W,ASHEA CONTRACTOR
CLOTHES WASHER ADDRESS
SWIMMING FOOL RL{EPTOR
CITY 61V TEL NQ.
LAWN SPRJNKLER SYSTEM STATE LIG
WATER HEATER NO. CLASS
1 GAS SYSTEM OUTLETS qFP ROVALS DATE IKSPCCTOR S 94NATURE
UNDER SLAD WORK
ROUGH PLUMBING
GAS-PI PI NG
GAS V ENI Qf
HOT WATER HEATER
PLUMBING FIXTURES
GAS TEST Q
Plan check fee LmUTYco.N&IHED _
PLUMBING RERMJT ISSUING FEE$
TOTAL FEE FINAL 0�
FlanFhock a plkam PLAN CHECK DATION
k—
Name I
Address 948A
CITY Tel.No. 0 0 o o o.5
I f1
HEHOY ACYYW FDQE T"T I HAVI FMAD THIS APPLICATION AND STATS
THATTHAuweua
11tBCOMCTAND �DorPLYWrMALL C04JNTYORDAANCES PERMIT VALIDATION 2 o o 1 0.00
AJO STATE
I HEREBY CIRIWY THAT I AH PROPERLY ftG—RED AND/OR L"XSiD AS O O O 1 Q 0 0
RECAJMD V LOS MOM-EZ COUNTY AND STATE Of CALVORMLA OR THAT I A✓II THL
LOCAL OWNER OF.AND INTEND TO RWDE IN THE MOVE DESCRIBED RESIDIN W
PROf'tm.
� (124-78
9FONATURS
EfPCRYnTEC �
D Epa NO. PSED BY
I N DUST RIAL
WASTE APPROVAL