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76 A 667—CE 817 8/68
APPLICATION FOR ' PLUMBING PERMI
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING {�
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY ^�
FOR APPLICANT TO FILL IN (PR NT OR TYPE) NEARESCROSSST.
NUMBER FIXTURE OR ITEM EACH FEE CROSS OWNER
WATER CLOSET 1.50
HAIL
BATHTUB 1.50 ADDRESS 4
SHOWER 1.50 CITY �( TEL. NO.•
LAVATORY 1.50 CONTRACTOR
SINK 1.50 ADDRESS I ,�
DISHWASHER 1.50 CITY .&L TEL. N04W I&g",y
CLOTHES WASHER 1.50 STATE LIC //.1
LICENSE NO. �L CLASS �
SWIMMING POOL RECEPTOR 1.50 DISTRICT NO GROUP ENE I P ES BY
LAWN SPRINKLER SYSTEM 2.00 2, ;)— O
WATER HEATER 1.50 INDUSTRIAL U
WASTE APPROVAL o
GAS SYSTEM OUTLETS 1.50 Q_ INSPECTION RECORD U
OUTLETS OVER .3G d-
5 PER SYSTEM
Z
Plan check fee 25% of above. See reverse.
PLUMBING PERMIT ISSUING FETE S 2 00
TOTAL HEI; 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 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
LICENSED AS REQUIRED BYWLANLES COUNTY AND STATEOFCALIFORNIA OR THAT I AMOWNER OF,AND INTEND TO
RESIDE IN, THE ABOVE DESCENTI PROPERTY. FINAL
SIGNATURE � JACK R. ALLEN, SUPERVISIN CHANICAL ENG-R.
OF PERMITTEE
PERMIT VALIDATION CK. M.O. CASH
PLAN CHECK VALIDATION CK. M.O. CASH
7?- 4 1 4 C t 2 0 5 0 3.5 011, c