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76A667 (CE-817) ( /
APPLICATION FO PLUM4kG PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO: FBUILDING
DREHARVEY T.•BRANDT, COUNTY ENGINEERCALITY
FOR APPLICANT TO FILL IN (PRINT OR TYPE) ARESTOSS ST.
NUMBER FIXTURE OR ITEM @ FEE
WATER CLOSET 1.75 OWNER
MAIL
BATH TUB 1.75 ADDRESS R-7 J
i SHOWER 1,75 CITY ��4✓l.(Qx. TEL. NO.
1 LAVATORY 1.75 1 CONTRACTOR 7 �"
1 SINK 1.75 l ADDRESS 0900 z, (1,te--
DISHWASHER 1.75 CITY Q - TEL. NO. Y5/Q-7070
C LOTHES WASHER 1'75 STATELIC
LICENSE NO. Q /C) /� CLASS
SWIMMING POOL RECEPTOR 1.75
DISTRICT NO. GROUP . CESSED.BY
LAWN SPRINKLER SYSTEM 1.75 �,l C3 - �/
WATER HEATER 1.75 INDUSTRIIA//L�J •L ZQ
WASTE APPROVAL
GAS SYSTEM OUTLETS 1.75 INSPECTION RECORD O
v
OUTLETS OVER
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5 PER SYSTEM .30 er��G '�r U � p
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+: - LLI
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Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEE $ 3 00
TOTAL FEE 7
APPROVALS DATE INSPECTOR'S SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
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
PLUMBING. GAS TEST
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED
LRE
SED AS REOU I RED BY LOS ANGELES COUNTY AND STATE OF
ORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO i
E IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY.oFINALA TU RE PERMITTEE
PERMIT VALIDATIONCK. M.O. CASH
PLAN CHECK VALIDATION CK. M.O. CASH
6 4 NOV "` 5 v 4.7 5