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APPLICATION FOR PLUMBING PER IT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUII.DING
ADDR
JOHN A LAMBIE COUNTY ENGINEER ESS
WILLIAM A JENSEN SUP T OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM OWNER
WATER CLOSET MALL
BATH TUB ADDRESS
CITY TEL NO
SHOWER
LAVATORY `
CONTRACTO
SINS ADDRESS
DISHWASHER
CITY
CONTRA OR S STATE ❑
LAIINDRY TUB REGISTRATION NO COUNTY
CLOTHES WASHER DISTRICT NO GR I ZO E P S BY
WATER HEATER
GASTEM INDUSTRIAL
WASTE APPROVAL }
INSPECTION RECORD CL
_ 0
O
d
N
Z
0 $100 PER ITEM
OR FIXTURE $ APP OVALS I1 �PATE INSPECTOR SSG ATURE
PERMIT $ 2 00 UNDER,3tSCB'WORK
i
TOTAL FEE l ROUGH PLUMBING
GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 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 THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED
SIGNATURE I /J A
OF PERMITT - FINAL `(�///Ir�-
VALIDATIO ROBERT A WOOD
CK M O CASH SUPERVISING MECHANICAL ENG R
LACO 1 7 8 5 JUL 18 5 D 350-
1
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