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APPLICATION FOR PLUMBING PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
rrOHN A. LAMBIE. Couatreer ADDEESS
CASBATT D.GROTM.Sup-t of Building LOCALITY
FOR APPLICANT TO FILL IN NEAREST
NUMBER FIXTURE OR ITEM CROSS ST.
OWNER
WATER CLOSET
MAIL '7r-
BATE TUB d t
SHOWER TEL.NO.
LAVATORY CONTRACTOR
SINS ADDRESS
DISHWASHER CITY ` TEL.NO.LAUNDRY �I
CO C STATE
T� REG ON NO. ®a� COUNTY ❑'
WATERCLOT=WASHES DISTRIp. Gly P ZONE I P S apimmommossm
BY
WATER BEATEB �, �
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
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APPROVALS
a r ff a°FIs o T= I; DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT $ 2H00 ROUGH PLUMBING myq
TOTAL.FEE GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. PLUMBING FIXTURES
I HEREBY CERTIFY THAT I AN PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO.NOTIFIED
DESCRIBED RESIDENTIAL OP TY. �ry
SIGNATURE FINAL ID'�/O'.�
OF PERMITTE ae�
ROBERT A.WOOD.
�F VALIDATIONS SUPERVISING MECHANICAL.ENG'R
CR. N.O. CASH
LAAO 4 J 5 g °A OCT 16 5 A 3.0 0 M
J,4/�, X 0�
76A667 (CE-817)-8-71
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDLD IRESNG S �� if
'
LOCALITY -
FBATHTUB
PPLICANT TO FILL IN (PRINT OR TYPE) NEAREST
CROSS ST.
FIXTURE OR ITEM @ FEE
OWNE d
ER CLOSET 1.75
MAIL
1.75 ADDRESS vWER 1.75 CITY EL. N
LAVATORY 1.75 CONTRACTOR /
SINK 1.75 ADDRESS
DISHWASHER 1.75 CITY TEL. NO. •� ��
CLOTHES WASHER 1.75 STATE LIC
®
SWIMMING POOL RECEPTOR 1.75 LICENSE CLASS
DISTRICT NO. GROUPZON P OCESS Y
LAWN SPRINKLER SYSTEM 1.75 -�"• D f�.
WATER HEATER 1.75 �� INDUSTRIAL CJ
WASTE APPROVAL
GAS SYSTEM OUTLETS 1.75 - INSPECTION CORD 0
OUTLETS OVER
5 PER SYSTEM .30
V
Lu
d
V!
Plan check fee See reverse.
PLUMBING PERMIT ISSUING FEE $ 3 00
TOTAL FEE
APPROVALS DATE INSPECTOR'S SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
City Tel. NO. GAS VENT
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. GAS TEST
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANO/OR UTILITY CO. NOTIFIED
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM T LE L OWNER OF; AND INTEND TO It
RESIDE IN THE ABOVE DES BED ESIDENT PR TY FINAL ! 7
SIGNATURE
OF PERMITTE
PERMIT VALIDATION M.O. CASH
PLAN CHECK VALIDATION CK. M.O. CASH
a", 7, 6 4C sEP7. 1 5 A 4.'75- Q