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APPLICATION FOR PLUMBING PE IT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS �� ca`
WILLIAM A. JENSEN, SUPT OF BUILDING
LOCALITY .
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET $1.25 MAIL
BATH TUB 1.25 ADDRESS
/ CITY TEL. NO.
r SHOWER 1.25
LAVATORY 1.25 CONTRACTOR
p i
SINK 1.25 ADDRESS 170
DISHWASHER 1.25 CITY �!-i P TEL. NO. 1�1,
LAUNDRY TUB 1.25 CONTRACTOR'S / STATE
REGISTRATION NO. _ ,3 COUNTY ❑
CLOTHES WASHER 1.25 DISTRI T N- . GROUP ZONE ESSED BY
WATER HEATER 1.50 f
GAS SYSTEM OUTLETS 1.50 INDUSTRIAL O_
WASTE APPROVAL O
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD U
U
CL
APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT S 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE cns 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.
I HEREBY CERTIFY THAT I A PROPERLY REGISTERED AND�OR PLUMBING FIXTURES
LICENSED AS REQUIRED OS A GELES N AND STATE OF GAS TEST
CALIFORNIA OR THAT M THE LEGAL NER OF,AND INTEND TO
RESIDE IN, THE ABO DESCRIBED REST NTIAL PR E UTILITY CO. NOTIFIED
SIGNATURE
OF PERMITTE -
FINAL
VA DATION ROBERT A. WOOD
CK.
M.0. CASH SUPERVISING MECHANICAL ENG'R
r, 5.75 -