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76A887 -CEMS 17 12 84
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS fv pQ
JOHN A LAMBIE COUNTY ENGINEER
COLEMAN W JENKINS SUPT OF BUILDING
LOCALITY�( � �
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM EACH FEE
OWNER T
r WATER CLOSET $1251 MAIL
BATH TUB 1 25 ADDRESS
SHOWER 125 CITY TEL NO
LAVATORY 125 CONTRACTOR4 Ir
SINK 125 ADDRESS
DISHWASHER 1 25 A k CITY c—1a lVA TEL NO 440-LAUNDRY TUB 125 REGISTRATION ON NO �p~Z 6 COSTATE
UNTY ❑
CLOTHES WASHER 125 DISTRICT NO GROUP ZONE PROCESSED BY
WATER HEATER 1 50 d
GAS SYSTEM / OUTLETS 1 50 INDUSTRIAL
WASTE APPROVAL d
OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD v
d'
O
F-
w
W
G.
N
I 2
I
' APPROVALS DATE INSPECTOR S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
f ROUGH PLUMBING
TOTAL FEE /ro 157< GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 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 L7]�j J�.�
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF AND INTEND TO
RESIDE IN THE ABOVE DESCRIBED IDENTIAL PROPERTY UTILITY CO NOTIFIED
SIGNATURE
OF PERMITT
C
ATION ROBERTA WOOD
M o CASH SUPERVISING MECHANICAL ENG R
LIIL05 1 5 0� AT 5 A 1 6.55
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