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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING /
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
WILLIAM A JENSEN SUP T OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN CROSS ST 7iV
NUMBER FIXTURE OR ITEM EACH fEE `Y
c OWNER
WATER CLOSET Sl 25 J C MAIL
BATH TUB 1 25 �; ADDRESS
�; CITY TEL NO
SHOWER 1 25
LAVATORY 125 5-v CONTRACTOR
SINS 125 ADDRESS S
DISHWASHER 1 25 CITY TEL NoAr
LAUNDRY fUB 1 25 CONTRACT A S STATE
REGISTRATION NO $ COUNTY
CLOTHES WASHER 1 25 .t DISTRICT NO GROUP ZONE BY
WATER HEATER 150j','PR7SSED
GAS SYSTEMOUTLETS 1 50 C INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD �-
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OAPPROVALS + DATE INSPEC-FOR 5 Si NATURE
PERMIT 5 2 00 UNDER SLAB WORK
ROUGH PLUMBING 7
TOTAL FEE ,
J O GAS PIPING t 1
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT 1
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND�OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO GAS TEST
RESIDE IN THE ABOVE DESCRIBED R IDENTIAL PROPERTY UTILITY CO NOTIFIED
?Al 100
SIGNATURE
OF PERMITTEE / 1
FINAL zo
LIDATION ROBERT A"V✓OOD
cK M O CASH SUPERVISING MECHANICAL ENG R
9 1 8 2%3' JAN 7 5 D 1500-