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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
;HAKE CHECKS PAYABLE TO: BUILDING
ADDRESS / (•
HARVEY T. BRANDT, COUNTY ENGINEER
LOCALITY Tqt.A le City
FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST
NUMBER FIXTURE OR ITEM @ FEE CROSS ST.
WATER CLOSET 1,75 1 i° OWNER Noel Baldwin
MAIL
BATH TUB 1.75 ADDRESS
SHOWER 1.75 % Gl CITY Tanis Cit TEL. 8,,,
LAVATORY 1,75 (, J t0 CONTRACTOR Bros, P lumbin
SINK 1.75 } ADDRESS N Baldwin
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DISHWASHER 1.75 CITY �MteTEL. NO.
CLOTHES WASHER 1.75 V STATE LIC
SWIMMING POOL RECEPTOR 1.75
LICENSE NO. 2-1 CLASS OP
DISTRICT NO. GROUP ZONE PROCESSED BY
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LAWN SPRINKLER SYSTEM 1.75
WATER HEATER 1.75 °-
1� INDUSTRIAL p
1 WASTE APPROVAL C;1
GAS SYSTEM °,/ OUTLETS, .75 INSPECTION RECORD w
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OUTLETS OVER 30 L`
5 PER SYSTEM
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Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEE $ 3 00
TOTAL FEE
APPROVALS DATE INSPECTOR'S SIGNATJ RE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
City Tel. No. GAS VENT
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
PLUMBING. GAS TEST
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED
LICENSED AS REOUI RED 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 PROPERTY. FINAL
SIGNATURE
OF PERMITTEE ` ey-'
PERMIT VALIDATION CK. M.O. CASH
PLAN CHECK VALIDATION CK. M.O. CASH
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