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APPLICATION OR PLU BING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO ADDRESS
HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY
FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST
CROSS ST. A
NUMBER FIXTURE OR ITEM @ FEE
OWNER
WATER CLOSET
200 „
MAIL
BATH TUB 2.00 ADDRESS ' +'led-
SHOWER
la SHOWER 200 CITY TEL. NO.
LAVATORY 200 CONTRACTOR
SINK 2 00 ADDRESS
DISHWASHER 2.00 CITY TEL. NO.
CLOTHES WASHER 200 STATE LIC
LICENSE NO CLASS
SWIMMING POOL RECEPTOR 2.00
DISTRICT NO.JGROUPJ �QNE PRO ESS BY
LAWN SPRINKLER SYSTEM 2 00
t
WATER HEATER 200 - O-d INDUSTRIAL
WASTE APPROVAL
GAS SYSTEM OUTLETS 200 INSPECTION RECORD 0
55 OUTLETS STTEMR .30 �L// C7
PERS
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Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEE $
TOTAL FEE 7735
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 GAS TEST
PLUMBING
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED
L
NSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
FORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO
DE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. FINAL
NATUREF PERMITTEES
PERMIT VALIDATION CK M.Q. cns�
PLAN CHECK VALIDATION CK. M.O. CASH
60 1r ( � 9 ' 5 D 7.5 O mac
A.