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APPLICATION FOR,
PLUMBING PERMIT,
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY-ENGINEER
,BUILDING AND SAFETY DIVISIONnu LID
# JOHN A. LAMBIE, COUNTY. ENGINEER .
COLEMAN"W, JENKINS. SUP T OF'BUILDING LOCALITY
1 RT
FOR APPLICANT TO FILL IN (PR NT OR TYPE) CR SS ST.
E
NUMBER 'FIXTURE OR ITEM EACH FE
O WNE
- WATER CLOSET 1,50 '
•MAIL f
BATH TUB 1.50 ADDRESS ,
SHOWER 1.50 CITY TEL. NO.
t LAVATORY, 1 50 CONTRAC A
SINK' 1 50 ADDRESS !� '�• ��"
DISHWASHER 1.50 CITY / TEL. NO.
r CLOTHES WASHER 1.50 ' LICENLIC
SE-NO NO /4 CLASS I
SWIMMING POOL RECEPTOR 1.50
DrSTRICT NO GROUP ZONE PROCESSED BY
LAWN SPRINKLER SYSTEM 2.00 Og L-
WATER HEATER 1 50 j IND EAWASP RO, CL
GAS SYSTEM OUTLETS 1 50 INSPECTION RECORD 0
OUTLETS OVER -
5 PER SYSTEM •30 Z,
Z,
Plan check fee 25% of above' See reverse.
PLUMBING PERMIT ISSUING FEE 8 2 00
TOTAL FEE
APPROVALS DATE INSPECTOR'S SIGNATURE.
Plan check applicant _ UNDER SLAB WORK ,
N
ame - ROUGH PLUMBING
ss GAS PIPING' _
GAS VENT
City - Tel. No. HOT WATER HEATER
REBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
TATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TESTINGREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND�OR UTILITY CO NOTIFIED
ED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OFRNIA OR THAT I A THE LEGAL OWNER OF,AND INTEND TO
IN,THE ABOVE DE RI D RESIDENTIAL PROPERTY FITURE � JACK R. ALLEN, SUPERVISING MECHANIC A,L ENGERMITTEE `%%��� / C�'[�
PERMIT VALIDATION CK M o CASH e
PLAN CHECK VALIDATION CK M O CASH
4 '0 4 APR 9 5 D 3.50-