HomeMy Public PortalAbout5922 PRIMROSE AVE_Plumbing__ 76A667—CE 817458 -
APPLICATION FOR PLUMBINO ,PERMI
COUNTY OF LOS. ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY I�MSION BUILDING.
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS pf�
COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN PR OR TYP.E) NEARS ST... 6G4 t
NUMBER FIXTURE OR ITEM EACH FEE CROSS
OWNER
WATER CLOSET 1.50KAM
BATH TUB 1.50 ADDRESQ& t
SHOWER 1.50 CITY TEL.
LAVATORY 1.50 CONTRACTOR v/ry l.C•��
SINK 1.50. ADDRESS .2C i
DISHWASHER 1.50 CITY TEL.
CLOTHES WASHER 1.50 STATE LIC_
LICENS NO. ,�1 CLASS
SWIMMING POOL RECEPTOR 1.50 DISTRICT O. GROUP ZONE PROCESSED BY
LAWN SPRINKLER SYSTEM 2.00
WATER HEATER 1.50 (/ INDUSTRIALSTE APPROVAL Z
GAS SYSTEM OUTLETS 1.50 INSPECTION RECORD O
OUTLETS OVER
5 PER SYSTEM .30
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O.
H
Z
Plan check fee 25% of above. See reverse.
PLUMBING PERMIT ISSUING FEE S 2 00
TOTAL FEE
APPROVALS DATE INSPECTOR'S SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
GAS VENT
City. Tel. N.O. HOT WATER HEATER
1 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 1 THE LEGAL OWNER OF AND INTEND TO
pESIDE IN.THE ABOVE CRI ED RESIDENTIAL PROPE FINAL
SIGNATURE JACK R. ALLEN, SUPERVISING MECHANICAL 'R.
OF PERMITTE
PERMIT VALIDATION CK. M.O. CASH
PLAN CHECK VALIDATION CK. M.O. CASH
&7830% JAN 2 5 a Qv
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