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APPLICATION FOR PLUMBI G PERMI
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
COLEMAN W JENKINS SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS SS
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSES Sl MAIL
BATH TUB 1 25 ADDRESSat
SHOWER 125 CITY TEL NO
LAVATORY 125 CONTRACTOR l
SINS 125 ADDRESS
DISHWASHER 125 CITY i TEL NO p22
STATELIC
LAUNDRY TUB 125 LICENSE NO — CLASS
CLOTHES WASHER 125 DISTRIVNO GR ZpjdE PftQCE €D BY
WATER HEATER 1 50 „� D K
GAS SYSTEM OUTLETS 150 INDUSTRIAL CL
0
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM 30 / INSPECTION RECORD U
O
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V
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N
Z
APPROVALS,,fj DATE INSP S SIGNATURE
PERMIT s 2 00 UNDER SLAB W A P-
ROUGH PLUMBING _ld�
TOTAL FEE GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP ICATION 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 CERTIACRIE
ERLY REGISTERED AND/OR PLUMBING FIXTURES 3
LICENSED AS REq ES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THOWNER OF AND INTEND TO
RESIDE IN THE ABONTIAL PROPERTY UTILITY CO NOTIFIEDSIGNATUREOF PERMITTEEc•6 FINAL
VALIDATION
CK
mo CASH
t 15 3-7'9�8 OCT 19 5 D 5.7 5N 4
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