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APPLICATTON FOR PLUMBI P MIT
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 LOCAL '
FOR APPLICANT TO FILL IN NEARS
CROSS ST
NUMBER FIXTURE OR ITEM EACH FEE
OWNEF
WATER CLOSET $1 25 MAIL
BATH TUB 1 Y5 ADDRESS
SHOWER 125 TEL N
LAVATORY 125 CONTRA O
SINK 125 ADDRESS l
DISHWASHER 125 CI EL NO
STATE LIC
LAUNDRY tUB 125 LICENSE CLASS
CLOTHES WASHER 1 25 DISTRICT NO G ZQNE PRO S D BY
WATER HEATER 150
GAS SYSTEM OUTLETS 150 INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER S PER SYSTEM 30 INSPECTION RECORD d
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APPROVALS DATE INSPECTOR S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE
CAS 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 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 ABOVE DESCRIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED
SIGNATURE
OF PERMITTEE
FINAL
LIDATION JACK R ALLEN
crc M O CASH SUPERVISING MECHANICAL ENG R
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