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78A887 -CEN817
APPLICATION FOR PLUMBI G PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
FNEAREST
IL
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JOHN A. LAMBIE. COUNTY ENGINEER
COLEMAN W. JENKINS, SUPT OF BUILDING ,
FOR APPLICANT TO FILL IN —
NUMBER FIXTURE OR ITEM EACH FEEOER J
WATER CLOSET $1.25 MAIL
BATH TUB 1.25 ADDRESS
SHOWER 1.25 CITY TEL. NO. 2 95�
LAVATORY 1.25 CONTRACTOR
SINK 1.25 ADDRESS
DISHWASHER 1.25 CITY T
LAUNDRY TUB 1.25 CONTRACTOR'S STATE El
REGISTRATION NO. COUNTY ❑
CLOTHES WASHER 1.25 DISTRICT NO. GROUP Z E PR C SS ZY
WATER HEATER 1.50
GAS SYSTEM OUTLETS 1.50 INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER S PER SYSTEM .30 INSPECTION RECORD
APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT s 2 00 UNDER SLAB WORK
_ ROUGH PLUMBING I� s
TOTAL FEE t -� GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT v
AND STATE.THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING I
HOT WATER HEATER
PLUMBING.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES A
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO GAS TEST l/�`/
��l�b�
RESIDE IN,TH ABOVE DESCRIBED ESIDE NTIAL PROPERTY. UTILITY CO. NOTIFIED
SIGNATURE
OF PERMITT
FINAL
VALIDATIO ROBERT A. WOOD
CK. M.O.r CA SUPERVISING MECHANICAL ENG'R
j '0 7 1 8 9u" NOV ;8 5 D 3.5 0~ Al
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