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— APPLICATION FOR PLUMBING `PERMIT
COUNTY OF LOS ANGELES •'
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION . BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
COLEMAN W. JENKINS. SUPT. OF BUILDING `
Locurrr
FOR APPLICANT TO FILL IN (PR NT OR TYPE? NEAREST
CAOSS sr. Z_ W6S,,q '
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET 1.50
BATH TUB 1.50 'I ADDRESS �
SHOWER 1.50 ! (] CITY n( L G/P/ TEL. NO. ag�-53Q 91
LAVATORY 1.50 CONTRACTOR .
3• "' 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. - GROUP ZONE PROCESSED BY
LAWN SPRINKLER SYSTEM 2.00 _ ,j r
WATER HEATER - 1.50 INDUSTRIAL f y_
WASTE APPROVAL O
GASSYSTEM / OUTLETS 1.50 j INSPECTION RECORD V
OUTLETS OVER 40 Z
5 PER SYSTEM
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Plan check fee 250 of above. See reverse.
PLUMBING PERMIT ISSUING FEE S 2 100
'DOTAL FEE / 0I3
_ APPROVALS DATE INSPECTOR'S SIGNATURE
Plan check applicant UNDER SLAB WORK �^
Name &r ROUGH PLUMBING
Address. SG 0. GAS PIPING
GAS VENT
City, y{jp/,Q �' Tel. NO'dk ''5349VWAT
V '
NOT WATER HEATER
1 HEREDY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION 1
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES 1 C
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST
PLUMBING.
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND(OR UTILITY CO. NOTIFIED
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF.AND INTEND TO
RESIDE IN. THE ABOVE DES9410ED RESIDENTIAL R PERTY. FINAL
SIGNATURE JACK R. ALLEN, SUPERVISING MECHANICAL ENG'R�
OF PERMITTEE
PE END VALIDATIONCK. M.O. CASH
AU
ON CHECK VALID AON CK. M.O. CASH ��
Vr„o .o g oma• MAY- 3 5 D 14.00-