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APPLICATION FOR PLUMBI'NG PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS 'S'Vd
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COi,EMAN W JENKINS SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSSSST
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET $125
093
BATH TUB 125 ADDRESS
CITY TEL NO
SHOWER 125
LAVATORY 1 CONTRACTOR
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SINK 125 ADDRESS
DISHWASHER 125 CITY TEL NO 7/��.►t G
CO CTO S STATE
LAUNDRY ruB 125 REGISTRATION NO � COUNTY ❑
CLOTHES WASHER 125 DISTRICT O G Z P BY
WATER HEATER 150 (�
GAS SYSTEM OUTLETS 150 WASTE APPROVAL d
OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD v
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Ca
W
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Z
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APPROVALS DATE INSPECTOR S SIGNATURE
PERMIT S 2 00 UNDER SLAB WORK fs'° / I
y� ROUGH PLUMBING `
TOTAL FEE !�? V GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT yF i
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY y
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER �I `
PLUMBING p
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES P
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF AND INTEND TO
RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED f
SIGNATURE r
OF PERMITTEE �,��
FINAL
/VALIDATION ROBERT A WOOD
I cK M o CASH SUPERVISING MECHANICAL ENG R
LACO2 0 7 A MAY 2 8 5 D 3.5 0-