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APPLICATION FOR PLUMBING PERM[
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) NEAREST
CROSS ST. D� r
NUMBER FIXTURE OR ITEM EACH FEE _
OWNER
WATER CLOSET 1.50
KAIL
BATH TUB 1.50 / ADDRESS b� e .JrLyd u at
SHOWER 1.50 - CITY r TEL
LAVATORY 1.50 CONTRACTOR
SINK 1.50 ADDRESS
DISHWASHER 1.50 CITY TEL. NO.
CLOTHES WASHER 1.50 0 STATE LIC
LICENSE NO. CLASS
SWIMMING POOL RECEPTOR 1.50 DISTRICT N ORO ZONE P.O 8BY
LAWN SPRINKLER SYSTEM 2.00 C3
Q v
WATER HEATER 1.50 INDUSTRIAL. �
WASTE APPROVAL 1C_D..
GAS SYSTEMOUTLETS 1.50 INSPECTION RECORD W
OUTLETS OVER 30 H
5 PER SYSTEM
Plan check fee 25% of above. See reverse.
PLUMBING PERMIT ISSUING FEE 8 2 100
TOTAL FEE // 1019
APPROVALS QATE INWECTORJS SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
GAS VENT
City Tel. No. HOT WATER HEATER
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES U. A JO
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST -/ �� � rG�j•�
PLUMBING.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO.NOTIFIED `
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF ND'INTIkND TO
RESIDE IN.THE ABOVE DESCRIBED RESIDENT PR RTY. FINAL
SIGNATURE JACK R. ALLEN, SUPERVISING MECHANICAL ENG-R.
OF PERMITTEE �w�
P
PLAN CHEC V IDATION CK. M.O. CASH ERMIT VALIDATION M.O. CASH
[ APR26 5 0 11.00-,
GE 617IREV,6/76)
es
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
ADDRESS Y40
NUMBER FIXTURE OR ITEM @ FEE
WATER CLOSET LOCALITY ��
cliy
NEAREST
BATH TUB CROSS ST.
SHOWER OWNER
LAVATORY MAIL ADDRESS,
SINK CITY TEL.
DISHWASHER CONTRACTOR
DOGS A J C
CLOTHES WASHER ADDRESS
SWIMMING POOL RECEPTOR h
' �, CITY Z a5 TEL.NO. _ 9d
LAWN SPRINKLER SYSTEM
STATELIC.
WATER HEATER LICENSE NO. _50CLASS
GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR'S SIGNATURE
OUTLETS-OVER UNDER SLAB WORK
5PER SYSTEM ROUGH PLUMBING �"�j/�Jc! •';..�,,,�;.' '
GAS PIPING
GAS VENT
ag
HOT WATER HEATER O
PLUMBING FIXTURES
GAS TEST wa
Plan check fee UTILITY CO.NOTIFIED
PLUMBING PERMIT ISSUING FEE$
TOTAL FEE FINAL
Plan check applicant PLAN CHECK VALIDATION Q
Name 2—A—75 5 r D
Address
City Tel.No.
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES HJT �� A
AND STATE LAWS REGULATING PLUMBING. PERMIT VALIDATION `"
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR.LICENSED AS 9 0 0 0 0 05
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I M THE
LEGAL OWNER OF.AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RE ENTIAL 2 n O 1 7 00
PROPERTY. f
SIGNATURE O D 0 1 a,0 G 3
CIF PERMITTEE
DISxIjIQ.� O ESSED BY 04, 1 2-79
INDUSTRIAL\J (�
WASTE APPROVAL