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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
F
JOHN A. LAMBIE, COUNTY ENGINEER 3WILLIAM A. JENSEN, SUPT OF BUILDING
FOR APPLICANT TO FILL IN .
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET $1.25 MAIL
BATH TUB 1.25 ADDRESS
f SHOWER 1.25 CITY TEL. NO.
LAVATORY 1.25 CONTRACTOR
SINK 1.25 ADDRESS
DISHWASHER 1.25 4REGISTRATION
TEL. NO.
LAUNDRY TUB 1.25 COUNTY STATE ❑
NO.CLOTHES WASHER 1.25 O. GROUP ZONE P SSED BY
WATER HEATER 1.50
GAS SYSTEM 5 OUTLETS 1.50 INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .30 _ INSPECTION RECORD �-
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03.N
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APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
Jar ROUGH PLUMBING °
TOTAL FEE V� GAS PIPING
I 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 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 INTEND TO
RESIDE IN, THE ABOV ESC D RESIDENTIAL P PERTv. UTILITY CO. NOTIFIED `
SIGNATURE
OF PERMITTEE w.�. .
FINAL
�LIDATION ROBERT A. WOOD
CK. M. O. CASH SUPERVISING MECHANICAL ENG'R