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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER -
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS e000 s
COLEMAN W. JENKINS, SUPT OF BUILDING •. LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST. C Z
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET $1.25 C? MAIL
I BATH TUB 1.25 ADDRESS a� Q
SHOWER 1.25 2 CITY TEL. NO.,
LAVATORY 1.25 Z CONTRACTOR
SINK 1.25 Z ADDRESS
/ DISHWASHER 1.25 CITY TEL. NO. G;o" w
LAUNDRY TUB 1.25 CONTRACTOR'S �3d� r-� STATE
REGISTRATION NO. 1T COUNTY ❑
CLOTHES WASHER 1.25 S DISTRICT NO. GROUP ZONE �P .r SSED BY�
WATER HEATER 1.50 d
GAS SYSTEM 4.o OUTLETS 1.50 INDUS IAL .�
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD
b
N
APPROVALS DATE INSPECT R'S SIGNATURE
PERMIT $ 2 OQ UNDER SLAB WORK
ROUGH PLUMBING i -
TOTAL FEE �� ,SS GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT .100
j AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
Y WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER dr
PLUMBING.
1 I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ' PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
t. CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO ;• GAS TEST
RESIDE IN,THE ABOVE DESCRIBE IDENTIAL PROPERTY UTILITY CO. NOTIFIED
1
SIGNATURE
OF PERMITTFTF7 /
FINAL
VALIDATION ROBERT A. WOOD
CK.
M.0. CASH SUPERVISING MECHANICAL ENG'R
. iLo 1 4 n Aug 31 5 A 1 6Jr
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