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APPLICATION FOR PLUMBIN PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIECOUNTY ENGINEER ADDRESS
WILLIAM A. JENS&, SUPT OF BUILDING LOCALIT
FOR APPLICANT TO FILL IN NEAREST
CROSS ST10,
NUMBER FIXTURE OR ITEM EACH FEE
OWNE cf
WATER CLOSET $1.25 Z 5� MAIL
BATH TUB 1.25 ADDRESS
SHOWER 1.25 CITY e , EL. NO d
LAVATORY 1.253 -1 S' CONTRACTOR
SING: 1.25 ADDRESS
DISHWASHER 1.25 CITY TEL. NO.
25 CONTRACTOR'S STATE �
REGISTRATION NO. COUNTY
LAUNDRY TUB 1. ❑
CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE PROCESSED BY
I WATER HEATER 1.50
GAS SYSTEM OUTLETS 1.50 t INDUSTRIAL D_
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD U
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APPROVALS DATE INSPECTOR'S SIGNATURE.
PERMIT JANDSTATE
2 00 UNDER`^S'I=AS WORK
ROUGH PLUMBING
TOTAL FEE
GAS PIPING is
I HEREBY ACKNOWLEDGE THAT 1 HAVE REPPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT ANDTO COMPLY
WITH ALL COUNTY ORDINANCES AND STATREGULATING HOT WATER HEATER
PLUMBING.
I HEREBY CERTIFY THAT I AM PROPERLYED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES CD STATE OF GAS TESTCALIFORNIA OR THAT I AM THE LEGAL OWNEINTEND TORESIDE IN,THE ABOVE DESCRIBED RESIDENTIA . UTILITY CO. NOTIFIED
SIGNATURE
OF PERMITTEFINAL
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LIDATION ROBERT A. WOOD
CK. M.O. CASH SUPERVISING MECHANICAL ENG'R
uo 5 0 3 3 LCT 21 0 1 1