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APPLICATION FOR PLUMBING PERMIT {�
COUNTY OF LOS ANGELES �J
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
AIA KE CHECKS PAYABLE TO BUILDING M LL- C/
ADDRESS
HARVEY T BRANDT, COUNTY ENGINEER LOCALITY _
FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST
CROSS ST Anfkj
NUMBER FIXTURE OR ITEM 0 FEE
WATER CLOSET 1 75 OWNER
MAIL
BATH TUB 1 75 ADDRESS p
SHOWER 1 75 CITY TEL NO
LAVATORY 1 75 CONTRACTOR b, F
SINK 1 75 ADDRESS /L100 j1ANIRIEREEMM", 40W,
DISHWASHER 1 75 CITY TEL NO
CLOTHES WASHER 17S STATE LIC /R�
LICENSE NO CLASS ` Q
SWIMMING POOL RECEPTOR 1 75
DISTRICT NO GROUP ZONE ROC ESSED BY
LAWN SPRINKLER SYSTEM 1 75 '' pp1`LLQ � �✓/J
WATER HEATER 1 75 1YASTETA PAPROVAL
9W1GAS SYSTEM OUTLETS 1 75 INSPECTION RECORD S
OUTLETS OVER IREGULAING
C
5 PER SYSTEM
W
OIL.
Z
Plan Check fee See Revere•
PLUMBING PERMIT ISSUING FEE S 00
TOTAL FEE
APPROVALS DATE INSPECTOR s SIGNATURE
Plan Check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
City Tel NOGAS VENT
HOT WATER HEATER
I HEREBY ACKNOWLEDGE THAT HAVE RIND THISCATION
AND STATE THAT THE ABOVE 16 LAND S AND LOMPLY PLUMBING FI%TURES
WITH ALL COUNTY ORDINAMC65 AND STATELLATINOPLUMBIRO GAS TEST
1 HEREBY CERTIFY THAT I AM PROPERLY REND/OR UTILITY CO NOTIFIED
LICENSEDAS REQUIRED BY LOS ANGELES COUNTATE OFCALIFORNIA OR THAT I AM THE L OAL OWNER OEND TORESIDE IN THE ABOVE DES CRIB SIDENTIAL PRFINAL
SIONATU RE
OF PERMITTEE ,
PERMIT VALIDATION QK M 0 CASH
PLAN CHECK VALIDATION CK u Q CASK
2 0 8�'*NOV 6 5 D n. 4.7 5 •a