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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
WILLIAM A JENSEN SUP T OF BUILDING 1p
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM EACH FEE OWNER
WATER CLOSET $1 25 �y
ADD SS v D C
BATH TUB 125 _
SHOWER 125 CITY I TEL NO .�
LAVATORY 125 CONTRAC A Wv
SINK 125 ADDRESS
DISHWASHER 125 CITY TEL N
CONTRACT S ' STATE
LAUNDRY TUB 125
REGISTRATION NO Q COUNTY ❑
CLOTHES WASHER 125 DISTRICT N G P Z % P E BY
WATER HEATER 1 50
GAS SYSTEM OUTLETS 1 SO INDUSTRIAL a
WASTE APPROVAL O
OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD U
Ix
O
H
U
W
a
N
Z
r�
APPROVALS DATE INSPECTOR IGNATURE
PERMIT $ 2 00 UNDER SLAB WORK P
ROUGH PLUMBINGv
TOTAL FEE GAS PIPING
1 HEREBY ACKNOWLLDGE THAT I HAVE READ THIS A PLICATION GAS VENT
AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY
LPL,UMBING
COUNTY ORDINANCES
AND STATE LAWS REGULATING HOT WATER HEATER
Y CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURESAS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
A OR THAT I AIG TH LEGAL OWNER OF AND�/I�/NTEND TO
THE ABOVEDE CR ED RESIDENTIAL P PE7Y Y UTILITY CO NOTIFIED
REMITTE J
MOMMOM FINAL
VALIDATIO,W"y ROBERT A WOOD
CK M O (�ASJJ SUPERVISING MECHANICAL ENG R
LAIoO 5 8 9- PAR 1PV12 D 4 75-