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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. SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN (PR NT OR TYPE) NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET 725 _
BATH TUB 1.50 ADDRESS
SHOWER 1.10 CITY TEL. NO. Q
LAVATORY 1. TRA
0 CONC A
SINK 1.10 ADDRESS
DISHWASHER 1. 0 CITY ! — TEL. NO.
CLOTHES WASHER 1. 0 ATE V LIC
STCENSEO 61T�CLASS
SWIMMING POOL RECEPTOR 1. 0 DISJJtICT NO. GRO E PRO SEED BY
LAWN SPRINKLER SYSTEM 2.10 �� �� CD
1IINDUSTRIAL v
, WATER.HEATER 1.5 WASTE APPROVAL �
GAS SYSTEM OUTLETS 1. 0 INSPECTION RECORD F=
OUTLETS OVER 0
S.PER SYSTEM
N
' Z
Plan check fee 25% of above. See reverse.
PLUMBING PERMIT ISSUING FEF. S 00
TOTAL FEE
APPROVALS DATE INSPECTOR'S SIGNATURE
Plan check applicant UNDER SLAB WORK
(damp � ROUGH PLUMBING
Address GAS PIPING
GAS VENT r
Cite Tel. No.
HOT WATER HEATER
I HEREBY ACKNOWLEDGE THAT 1 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 I AM PROPERLY REGISTERED AND/OR 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
aDEHE ABOVE D CRIBED RESIDENTIAL PROPERTY. FINAL
EJACK R. ALLEN, SUP ERVI GIMECHANICAL NG'Fi.
ITTE '
PERMIT VALIDATIO CK. M.O. CASH
PLAN CHECK VALIDATION CK.� M O. CASH
LACo.4'7 5' 7 r—':;, MAR 6 5 .D 4.2 5- c