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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING
JOHN A. AMBIE. COUNTY ENGINEER ADDRESS
L.
COLEMAN W: JENKI.NS. SUPT. OF BUILDING. LOCAL `� �7 �T
FOR APPLICANT TO FILL IN PR NT OR TYPE NEAREST G•�
CROSS ST. y f�-
NUMBER FIXTURE OR ITEM EACH FEE
WATER CLOSET 1.50 OWNER NAP, ZZ11P14s,1;, 7—
MAIL -
BATH TUB 1.50 ADDRESS
SHOWER 1.50 TEL.NO.
LAVATORY 1.50 CONTRACTOR
SINK 1.50 ADDRESS
DISHWASHER 1.50 CITYG � T:-TEL.NO.
CLOTHES.WASHER 1.50 STATELIC
LICENSE NO. _� CLASS
SWIMMING POOL RECEPTOR 1.50 _ DISTRICT NO. GROUP ZONE PROCESSED BY .
LAWN SPRINKLER SYSTEM 2.00 `D k {
WATER HEATER 1..5.0 INDUSTRIAL
APPROVAL
/ GAS SYSTEM OUTLETS INSPECTION RECORD
OUTLETS OVER
5 PER SYSTEM .30
O
BY1J
I�
g'
Plan. check fee 25% of above. See reverse.
PLUMBING PERMIT ISSUING FEE-E
TOTAL FEE
APPROVALS DATE INSPECTOR'S SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
GAS VENT
City Tel. No. 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
PLUMBING. GAS TEST
'1HEREBY CERTIFY'THAT 1 AN ROPE LY REGISTERED AND/OR UTILITY CO.NOTIFIED
LICENSED AS REQUIRED BY L08 NGELE COUNTY AND STATE :OF
CALIFORNIA OR THAT 1 AM THE LSO NER OF,.AND INTEND TO--
RESIDE IN..THE ABOVE DESCd ESIDE TIAL PROPERTY. FINAL
SIGNATURE
PERMITTEE-
4 � JACK R. ALLEN SUP R I5UCK
HANICAL'ENG'R.
OF PERMITTEE
PERMIT VALIDA I leiM.0. CASH
PLAN CHECK VAI, DATIO CK. M.O. CAS�HCu
�`nA p
•' Lf tUV 9 0 7 1- Al R 3 r 9.50
Q'
76A 6507 CE 817 8/68
A.PPLIC 10 FOR UMBIN ERMIT
COUNTY OF LO ANGELES
• DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
FADDR�ESSJOHN A. LAMBIE, COUNTY ENGINEERCOLEMAN W. JENKINS. SUPT. OF BUILDING FOR APPLICANT TO FILL IN(PRNT OR TYPE) ga
L
NUMBER FIXTURE OR ITEM EACH FEE -
OWNEA
WATER CLOSET 1.50
IL BATH TUB 1.50 ADDU I r C
SHOWER 1.50 TY TEL.
LAVATORY 1.50 CONTRACT .`
SINK 1.50 ADDRES a C�
DISHWASHER 1.50 / TEL. NO
CLOTHES WASHER 1.50 STATE d� - LIC
LICENSE CIkS$
SWIM6lING POOL RECEPTOR 1.50 DISTRICT NO. . 65pup ZONE PROC BY d
LAWN SPRINKLER SYSTEM 2.00 CD
V
WATER HEATER 1.50 INDUSTRIAL Z
WASTE APPROVAL o
GAS SYSTEM OUTLETS 1:50 INSPECTION RECORD W
OUTLETS OVER .30
5 PER SYSTEM ty
Plan check fee 25% of above. See reverse.
PLUMBING PERMIT ISSUING FLE 8 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. 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. 10
i HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO.NOTIFIED `� �+.�'
LR,E
ENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF �er•- rj
IFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO _
IDE IN,THE ABOVE DEBCRIBED REST NTIAL PROPERTY. FINAL
NATUREa�7 V44 "
JACK R. ALLEN, SUPERVISING HANI CAL ENG'R.
F PERMITTEE
PERMIT VALIDATION cK • M.o. CASH.
PLAN CHECK VALIDATION CK. M.O. CASH
�f 8 5 2 z.- JAM 2 7 5 D 35 a