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"APPLICATION FOR PL BING . PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING //J(�
BUILDING AND SAFETY DIVISION ADDRESS '/�'j'd
JOHN A. LAMBIE, COUNTY ENGINEER
COLEMAN W. JENKINS. SUPT OF BUILDING LOCALITY 4�PkLr- T
FOR APPLICANT TO FILL IN PR NT OR TYPE) NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE ,^ � -.
OWNER (J 14`;
WATER CLOSET 1.50 o
BATH TUB 1.50 ADDRESS
SHOWER 1.50 ` S� CITY TEL. NO.
LAVATORY 1.50 CONTRACTOR A,4 A-106
SINK 1.50 ADDRESS
DISHWASHER 1.50 CITY y v�� TEL. NO.
CLOTHES WASHER 1.50SATE LIC
I SO LICENSE NO. Z 0 CLASS
SWIMMING POOL RECEPTOR 1.50 DISTRICT N GROUP ZONE P CESSED BY
LAWN SPRINKLER SYSTEM 2.00CL
,J�� A _. I �� U
WATER HEATER 1.50 INDUSTRIAL
WASTE APPROVAL 0
GAS SYSTEM OUTLETS 1.50 INSPECTION RECORD ~
U
OUTLETS OVER - W
5 PER SYSTEM •30 D_
N
Z
Plan check fee 25% of above. See reverse.
PLUMBING PERMIT ISSUING FEE S 2 00
TOTAL FEE 06
APPROVALS DATE INSPECTOR'S SIGNATURE
Plan check applicant UNDER-SLAB WORK
Name ROUGH PLUMBING J G �ol .'
Address GAS PIPING
GAS'VENT
City 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 '•�
RESIDE IN, THE ABOVE DE CRIBED RESIDENTIAL PROPERTY. FINAL
SIGNATURE ...+ JACK R. ALLEN, SUPERVISING MECHANICAL ENG'R.
OF PERMITTEE �'���
PERMIT VALIDATION CK. M.O. CASH
PLAN CHECK VALIDATION CK. M O. CASH
6 4:7 71 SEP 19 5 tD 8.0,0-
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78A887 (CE-817) - 1/75 1
f` APPLICATIO FOR P MBING PERMIT {�
COUNTY OF LOS ANGELES
LJ
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO: BUILDING VY e17ne /� J t�[
ADDRESS 7 v !��
HARVEY T. BRANDT, COUNTY ENGINEER
LOCALITY / l
FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST . l�/f
�T
NUMBER FIXTURE OR ITEM @ FEE CROSS ST
Af
WATER CLOSET 2.00 OWNER G 0�&�/�
MAIL
BATH TUB 2 00 ADDRESS /7
SHOWER 2.00 CITY TEL. J0. Z F —70,4Z
LAVATORY 2.00 CONTRACTOR
SINK - 2.00 ADDRESS
DISHWASHER 2.00 CITY L. NO.
CLOTHES WASHER 2.00 STATE LIC\
LICENSE NO CLASS
SWIMMING POOL RECEPTOR 2.00
DISTRICT NO.GROUP NE 7-PRO)CIESSEP,BY
LAWN SPRINKLER SYSTEM 2.00 SUv 011
WATER HEATER 2.00 INDUSTRIAL
WASTE APPROVAL
GAS SYSTEM OUTLETS 2.00
INSPECTION RECORD
CD
OUTLETS OVER V
5 PER SYSTEM .30
O
F--
U
W
CL.
GO
Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEE $
TOTAL FEEJv
APPROVALS DATE INSPECTOR'S SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING I
City /Tel. NO. GAS VENT
HOT WATER HEATER
I 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 I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED
LICENSED AS REOU I RED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO /f
RESIDE IN-THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. FINAL ®�26 /4,�'��"�'-t
SIGNATURE OA
OF PERMITTEE
PERMIT VALIDATION CK. M.O. CASH
PLAN CHECK VALIDATION CK. M.O. CASH EJ'I 7.5 O
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