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76A667 CE#817 6 65
APPLICATION FOR PLUM ING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING .y/
JOHN A LAMBIE COUNTY ENGINEER ADDRESS �T (/ \
COLEMAN W JENKINS SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM EACH FEE C
OWNER r i T.l
WATER CLOSET $1 25
BATH TUB 1 25 DRESS �Q
SHOWER 125 CITY C'AtA TEL NO — 3
LAVATORY 125 CONTRACTOR
SINK 125 ADDRESS
DISHWASHER 12S CITY L.Cpi TEL NO 2 3Y
LAUNDRY TUB 1 25 STATE LIC
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LICENSE NO .�L[/ (O /Jt7 CLASS ^3
CLOTHES WASHER 1 25 DISTRICT NO GRO PZONE PRO SED BY
WATER HEATER 1 50 `
It GAS SYSTEM OUTLETS 1 50 INDUSTRIAL
WASTE APPROVAL O
OUTLETS OVER S PER SYSTEM 30 INSPECTION RECORD V
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APPROVALS DATE INSPECTOR S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION 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
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TES !jam
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO
RESIDE IN THE ABOVUSED
DE RESIDENTIAL RESIDENTIAL PROPERTY UTILI O OTIFIED
P Qr6
SIGNATURE ,dY
OF PERMITTEET&alar
FINAL
UDATION
CK M O CASH
LAW 1 4 5 710 APR 21 5 D 5 G 0cl-
1 VA_