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APPLICATION FOR PERMIT
DEPARTIRENT OFNG MSAFETY PLUMBING i
OOIINTY OFF LOS
AS ANGELXES
WILLIAM J. FOX, DHIv ENGINEER
FOR APPLICANT TOU.
FILL IN I - _
PLUMBER • READY FOR
BY FIRST INSPECTION DAT ISSUED
ADORERS
CITY �/F
TEL.
N �+— 7I� ADDRESS A-
BUILDING
�I
COUNTY Emma V Q JAY LOCALITY
N[ARERT
PERMIT FEES cwom Rr
MYMRW T of It%H!R[os R FEC OWNER
WATER CLOSET(TOILET) ! O BO R ADIL
DRESS
BATH TUB @ 050 CITY TEL,
SHOWER @ Oon I HEREBY ACKNOWLEDGE THAT 1 14AV[ READ THIS
LAVATORY (WASH RABIN) @ ago APPLICATION AND STAT[ THAT THE ABOVE IR CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY to
KITCHEN BINK @ 050 AND STATE LAWB RKBULATIMG PLUMBING.
1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY ® 030 ANBELER COUNTY LIOENRE. R I AM THE LEGAL OWNER
GAS SYST[
OF THE REGIDENTIAL�[ D RIBZD ARgm
OUTLETS @ O 60 SIGNATURE OF el
WATER HEATER Y coo PERMITTEE
SLOP RINK a D 50 INSPECTION RECORD
►Loon SINK @ O BD
FLOOR DRAIN @ moo
DISHWASHER D.BO
DRINKING FOUNTAIN O Bo
URINAL @ O.BC J
HOUR[ WEINER @ OBC ZZZV_
MIRO [OUB
APPROVALS
DAT[ INEPED mm NAME
ROUGH PLUMBING
GAS PIPING I'r�
GAB VENT
DEMP00L @ 1 GO CESSPOOL
BCPTIO TAHKt SEPTIC TANK
DRAIN ( ) PIT ( ) @ I W SEWER
PERMIT I oo
UTILGAG TEST
ITY c0 NOTIFIED
TOTAL FEE R rC� rl
]BARB] (CE-817)-4/72 7+- / J) // /�Mp/t /� S
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING ? (�
MAKE CHECKS PAYABLE TO ADDRESS 3 V A d7-
HARVEY T BRANDT, COUNTY ENGINEER LOCALITY : M
FOR APPLICANT TO FILL IN IPRINT OR TYPE) NEAREST
CROSS ST GLS
NUMBER FIXTURE OR ITEM O FEE Alai)
WATER CLOSET 1 75 a� OWNER
J MAIL
BATH TUB 1 75 ADDRESS
SHOWER 1 75 CITY TEL NO
LAVATORY 1 75 CONTRACTOR /
SINK A 75 ADDRESS/Qq
DISHWASHER 1 75 CITY TEL NO//`l/.:t-'7()'70
CLOTHES WASHER 1 75 STATE LIC
SWIMMING POOL RECEPTOR 1 75 LICENSE NO CLASS
DISTRICT NO GF.QUP NE CESSE BY
LAWN SPRINKLER SYSTEM 1 75
WATER HEATER 1 75 INDUSTRIAL
OVAL y
WASTE AP GO.
GAS SYSTEM OUTLETS 1 75 INSPECTION RECORD Ci
OUTLETS OVER
5 PER SYSTEM 30 p
i
66" 1Ae
Plan Check fee See Rev.,[*
PLUMBING PERMIT ISSUING FEE $ a 00
TOTAL FEE
APPROVALS DATE INSPECTOR v 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 1 HAVE READ THIS APPLICATION
AND STATE THAT THEABOVE IB CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY 0ROINANCO AND STATE LAWS REGULATING
PLUMBING GAS TEST
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AMD/OR UTILITY CO NOTIFIED
LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO
RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PR ERTY FINAL
-07
SIGNATU RE
OF PERMITTEE
PERMIT VALIDATION cK M O CASH
PLAN CHECK VALIDATION CK M cAex
i p� 2 9 5 073 AUG 27 5 D 6 .50A