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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING ?ZlJ ,n-S
JOHN A LAMBIE COUNTY ENGINEER ADDRESS JJ v7
COLEMAN W JENKINS SUP T OF BUILDING LOCALITY TE h`
FOR APPLICANT TO FILL IN CROASS ST l/
NUMBER FIXTURE OR ITEM EACH FEE
OWNER D fk
WATER CLOSET $1 25 MAIL ,�Fre_S
BATH TUB 1 25 ADDRESS S/7If
SHOWER 125 CITY TEL NO
LAVATORY 125 CONTRACTOR
SINK 1 25 ADDRESS
DISHWASHER 125 CITY TEL NO
LAUNDRY ruB 1 25 R GINSTTRAT ON NO COUNTY p
CLOTHES WASHER 1 25 DISTRICT NO GROUP ZONE P SSED BY
WATER HEATER 150 ,& `i- n
GAS SYSTEM _OUTLETS 1 50 INDUSTRIAL
WASTE APPROVAL d
OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD
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APPROVALS DATE INSPECTOR S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
ROUGH PLUMBING /
TOTAL FEE GAS PIPING (�
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING I
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
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CALIFORNIA OR THAT 1 THE LEGAL OWNER OF AND INTEND Tp e�
RESIDE IN THE ABOVE GAS TEST
DESCRIBED RESIDENTIAL PROPERTY (,^J,✓j_ / UTILITY CO NOTIFIED
SIGNATURE
OF PERMITTEE
FINAL
VALIDATI ROBERT A WOOD
CK M O (\CASH SUPERVISING MECHANICAL ENG R
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