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APPLICATION FOR PLUMBING PERMI ?
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS 6348 Golden W st
JOHN A. LAMBIE. COUNTY ENGINEER
COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY Temple City
FOR APPLICANT TO FILL IN (PR NT OR TYPE) NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE
WATER CLOSET 1.50 O OWNER Dick Bowen
MAIL 1620 Melanie Lane
/ BATH TUB 1.50 O ADDRESS
SHOWER 1.50 CITY
Arcadia TEL. NO.
LAVATORY 1.50 Q CONTRACTOROwen Bros. Plumbing, Tnp—
SINK 1.50 �� ADDRESS 4265 North Baldwin Avenue
DISHWASHER 1.50 L 5-b crnEl Monte 917 .
31 TEL. NO. 443-007
CLOTHES WASHER 1.50 STATE 7LIC
LICENSE NO. 231 141 CLASS C36 sc20
SWIMMING POOL RECEPTOR 1.50
DISTRICT NO. GRO P ZptlE PlN S BY
LAWN SPRINKLER SYSTEM 2.00 /���ls �. p
Ye
WATER HEATER 1.50 INDUSTRIAL C7
WASTE APPROVAL Zo
GAS SYSTEM OUTLETS 1.50 INSPECTION RECORD
OUTLETS OVER v
5 PER SYSTEM .30 'x'1 C/.1LN
Plan check fee 25% of above. See reverse.
PLUMBING PERMIT ISSUING FEE 8 2 00
TOTAL FEE
APPROVALS D TE IN CTOR' S NATURE
Plan check applicant UNDER SLAB WORK
Dame ROUGH PLUMBING
A(ldress GAS PIPING
GAS VENT
City Tel. No. HOT WATER HEATER
1 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.
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANWOR UTILITY CO. NOTIFIED
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO
RESIDE IN,THE ABOVE DEB IBED RESIDENTIAL PROPERTY. FINAL /
SIGNATURE JACK R. ALLEN, SUPERVISING MECHANICAL ENG-R.
OF PERMITTEE ca j
//��+�;
PERMIT VALIDATION C}(. M.O. CASH
PLAN CHECK VALID TION CK. M.O. CASH
_ 7 5 D 1 8.5U
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