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76A667 -CE#817 12-64
APPLICATION FOR PLUMB G PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER n h
BUILDING AND SAFETY DIVISION BUILDING 0
ADDRESS J O ��tt d Y{
A J4122
JOHN A LAMBIE, COUNTY ENGINEER
COLEMAN W JENKINS,SUPT OF BUILDING LOCALITY T pLE CJ-s
FOR APPLICANT TO FILL IN NEAREST '� C , N l-r- /1
CROSS ST J�
NUMBER FIXTURE OR ITEM EACH FEE OWNER
WATER CLOSET $125 p�Ul'` {
BATH TUB 125 ADDR-E-S7S� J d�--� - C Fps 1Z
SHOWER 125 Cl!'Y I M PZ-�. J'r TEL NO A 6 (oZ
LAVATORY 125 CONTRACTOR �C° �, �,),is-y R
SINK 125 ADDRESS')( 91-O G!�N p A U 6
DISHWASHER 125 CITY -Tc--NA Q C J TyEL NO-q
LAUNDRY TUB 1 CONTRACTOR'S STATE p
REGISTRATION NO Z i I 9 COUNTY ❑
CLOTHES WASHER 125 DIS NO GR P ONE
P=CESILBY
WATER HEATER 150 I i Q
GAS SYSTEM OUTLETS 150 INDUSTRIAL
WASTE APPROVAL d
OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD O
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N
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APPROVALS DATE INSPECTOR S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY RGrp;
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER ;1314,4 c\,i�;iyl�d
PLUMBING
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
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
SIGNATURE
OF PERMITTEE ,
FINAL
o •
VALIDATION ROBERT A WOOD
CK M o CASH SUPERVISING MECHANICAL ENG R
LAGO8 4 0 9 N DEC30 5 0 3.50^'