HomeMy WebLinkAboutN/A (1341)76A667 (CE-817) - 5/73
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
MAKE CHECI<S PAYABLE TO: BUILDING
ADDRESS
e
HARVEY T. BRANDT, COUNTY ENGINEER
,
LOCALITY
NEAREST
CROSS ST.
OWNER
FOR APPLICANT TO FILL IN (PRINT OR TYPEI
NUMBER
FIXTURE OR ITEM
@
FEE
WATER CLOSET
1.75
MAIL
BATH TUB
1.75
ADDRESS
SHOWER
1.75
CITY TEL. NO.
CONTRACTOR T,= - j V .&' "A
LAVATORY
1.75
SINK
1.75
J
ADDRESS��r
DISHWASHER
1.75
/P
CITY C TEL.
CLOTHES WASHER
1.75
STATE j J 9( LIC € p
LICENSE NO. 7 CLASS
SWIMMING POOL RECEPTOR
1.75
DISTRICT NO. GROUP ZONE PROCESSED BY
LAWN SPRINKLER SYSTEM
1.75
WATER HEATER
1.75
INDUSTRIAL
WASTE APPROVAL
GAS SYSTEM OUTLETS
1.75
INSPECTION RECORD
OUTLETS OVER
5 PER SYSTEM
.30
/fib /6,—'k A6-1
100,
Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEE $
3
00
TOTAL FEE
APPROVALS
Plan check applicant
UNDER SLAB WORK
Name
ROUGH PLUMBING
Address
GAS PIPING
City Tel. N0.
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
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING.
I HEREBY CERTIFY THAJ I PROPERLY REGISTERED AND/OR
LICENSED AS REOUIRWBY O ANGELES COUNTY AND STATE OF
CALI FORMA OR TH�T I AM LEGAL OWNER OF, AND INTEND TO
RESIDE IN THE ABOV .4_ES RESIDENTIAL PROPERTY.
SIGNATU RE 4 1'
OF PERMITTEE-,
PLUMBING FIXTURES
GAS TEST
UTILITY CO. NOTIFIED
FINAL
PERMIT VALIDATION
PLAN CHECK VALIDATION CK. M.O. CASH
DATE INSPECTOR'S SIGNATUR
M.O. CASH