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76A667-CE#817 2-66
APPLICATION FOR PLUMBING ER IT
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 �� /�
FOR APPLICANT TO FILL IN NEAREST xll�'49- v 0
CROSS ST. 40
NUMBER FIXTURE OR ITEM EACH FEE /
OWNER
WATER CLOSET $1.25 `
MAIL q111-6
/ �G
BATH TUB 1.25 ADDRESS (,� L
SHOWER 1.25 CITY EL. NO.
LAVATORY 1.25 CONTRACTOR
SINK 1.25 ADDRESS
DISHWASHER 1.25 CITY TEL. NO.
STATE LIC
LAUNDRY TUB 1.25 LICENSE NO. CLASS
c
CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE ROCS D BY
WATER HEATER 1.50 5 f j::-
'
GAS SYSTEM OUTLETS 1.50 INDUSTRIAL a
WASTE APPROVAL O
OUTLETS OVER 5 PER SYSTEM .30 v
INSPECTION RECORD �
O
U
W
A,
APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTfiTT ATE LAWS REGULATING HOT WATER HEATER '
PLUMBING.
I HEREBY CERTILY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQCOUNTY AND STATE OF AS TEST
CALIFORNIA OR THNER INTEND TORESIDE IN, THE ABERTY. UTILITY CO. NOTIFIED
SIGNATURE
OF PERMITTEE FINAL —/
VALIDATIQN—T-) JACK R. ALLEN
CK. M.O. 1`CASH SUPERVISING MECHANICAL ENG'R.
5: 7 7 8:8 NOV 10 5 0 3-50-
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