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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION rADDRE'SS
UILDNG D�
JOHN A LAMBIE COUNTY ENGINEER WILLIAM A JENSEN SUP T OF BUILDING OCALITYFOR APPLICANT TO FILL IN EAR ' 4
EST
ROSS ST
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET $1 25
BATH TUB 125
ADDRESS
CITY et ILT
NO
sxowER 125
LAVATORY 125 CONTRACTOR
SINS 125 ADDRESS
DISHWASHER 125 CITY sl� TEL NO Q12
LAUNDRY TUB 125 CONTRACTOR STATE
REGISTRATION NO COUNTY ❑
CLOTHES WASHER 1 25 DISTRICT NO GROUP ZONE P CESSED BY
t WATER HEATER 150 O /r d
GAS SYSTEM OUTLETS 150 INDUSTRIAL CL
WASTE APPROVAL O
OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD U
O
H
V
W
4.
N
Z
APPROVALS DATE INSPECTOR S SIGNATURE
PERMIT S 2 00 UNDER SLAB WORK r
ROUGH PLUMBING
TOTAL FEE S(7 GAS PIPING i
I HEREBY ACKNOW Lt DGE THAT I HAVE READ THIS APPLICATION �—
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT 9 I
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING hi
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND TEND TO
RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED
SIGNATURE
IN OF PERMITTEE co
FINAL * f� ` 6
LIDATION ROBERTA' WOOD
CK M O CASH SUPERVISING MECHANICAL ENG R
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�kl 5;6 8 MAY 12 5 D 50
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