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APPLICATIO FOR PL BING 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 NEAREST
CROSS ST Ll
NUMBER FIXTURE OR ITEM EACH FEE
� OWNER
WATER CLOSET 3125 MAIL
BATH TUB / 1 25 ADDRESS
SHOWER 125 CITY TEL vol ,9
LAVATORY 125 CONTRACTOR
SINS 1 25 ADDRESS
DISHWASHER 1 25 CITY G^ TEL NO
CONTRACTORS / STATE
LAUNDRY ruB 1 25 ---t ❑
REGISTRATION NO d U � COUNTY ❑
CLOTHES WASHER 1 25 DISTRICT NO GROUP ONE ESSED BY
WATER HEATER 150 l
GAS SYSTEM OUTLETS 1 50 INDUSTRIAL a
WASTE APPROVAL 0
OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD U
Ix
0
F-
U
W
D_
U)
Z
APPROVALS DATE INSPECTOR S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
ROUGH PLUMBING \ i
TOTAL FEE GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT I
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
PLIUMBING TH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
42
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND�OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST 6
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO p
RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED
SIGNATURE `
OF PERMITTEE , 42
FINAL /I
VALIDATION ROBERT A'W60D
CK M O CASH SUPERVISING MECHANICAL ENG R
i_r1�o 7 2 4 2 NPR 5 D 3 25-