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APPLICATION FOR PLUMBING 9ERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY
a
FOR APPLICANT TO FILL IN NEAREST
CROSS ST. .,o
NUMBER FIXTURE OR ITEM EACH FEE OWNEF
WATER CLOSET SIM MAIL I 4^
BATH TUB 1.25 I ADDRESS
SHOWER 1.25 CITY 1 TEL. NO,
LAVATORY 1.25 CONTRACT `
SINK 1.25 ADDRESS go Q .� Cs C. °
DISHWASHER 1.25 CITY TEL. NO,,.7IIkr/l.� 7f
STATE LIC
LAUNDRY TUB 1.25 LICENSE NO. CLASS
CLOTHES WASHER 1.25 DISTRICT NO. G. RO ZO PROCESSED BY
WATER HEATER 1.50 -
GAS SYSTEM_ OUTLETS 1.50 U INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD d
O
U
_ O
V
W
CL
N
Z
APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT. $ Z 00 UNDER SLAB WORK
-- ROUGH PLUMBING
TOTAL FEE
GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE AS CORRECT AND AGREE TO COMPLY _
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
1 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 A OVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO. NOTIFIED
SIGNATURE _
OF PERMITTEE
FINAL
LIDATION JACK R. ALLEN
CK.
M.O. CASH SUPERVISING MECHANICAL ENG'R. -
�t o 2 sty 8 5 D 3.5 ON