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APPLICATION FOR PLUMBING PER
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER n
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS /7F
JOHN A LAMBIE COUNTY ENGINEERPZ
WILLIAM A JENSEN SUP T OF BUILDING f
LOCALITY f /
' FOR APPLICANT TO FILL IN NEAREST
CROSS ST n J
NUMBER FIXTURE OR ITEM EACH FEE OWNER
WATER CLOSET $1 25 2 5 d MAIL
BATH TUB 1 25 1 2
- ADDRESS 1
SHOWER 125 CITY TEL NO
r
Z. LAVATORY 125 Z 15716
CONTRACTOR LutjL
SINS 1 25 Z S-- ADDRESS C-_>
DISHWASHER 125 CITY � TEL NO 1—12 7 9'0 6
LAUNDRY TUB 125 CONTRACTOR S STATEREGISTRATION NO 127 is S G COUNTY ❑
CLOTHES WASHER 1 25 Z DISTRICT NO UPANE PROCESS DY
WATER HEATER 150 S Q ' � }
AL -� a
GAS SYSTEM OUTLETS 1 WASTE T APPROVAL 0
OUTLETS OVER 5 PER SYSTEM 30 SPECTION RECORD
7 Ix
O
it a
4 .��� �` z
APPROVALS PATEJ INSPECTOR S SIG AT Rt:
rPERMIT S 2 00 UNDER SLAB WORK G
ROUGH PLUMBING r J
TOTAL FEE 7S^
GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI ATION GAS VENT \
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING HOT WATER HEATER
1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES A
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST f
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO
RESIDE IN THE ABOVE DESCRIBEZRES[DgNTIAI.-;P ROPERTY UTILITY CO NOTIFIED
SIGNATURE �I
1 OF PERMITTEE FINAL
/--"LIDATION ROBERT A WOOD
cK M o CASH SUPERVISING MECHANICAL ENG R
LAO 5 e 5 5-D F ED 4 5 D 1375-