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APPLICATION FOR PLUMBI G PER ,
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING �� G
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
COLEMAN W JENKINS SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM EACH FEE /
OWNER
WATER CLOSET $125 MAIL
BATH TUB 125 ADDRE c
SHOWER 1 25 CITY TEL NOt t �
LAVATORY 125 CONTRACT
SINK 125 ADDRESS )7y,-f
DISHWASHER 125 CITY TEL NV'&--1 7j
STATE LIC
LAUNDRY TUB 125 LICENS NO CLASS
CLOTHES WASHER 1 25 DISTRICT N GR ZO�E P`RO E E BY
WATER HEATER 150 U t ,
GAS SYSTEM OUTLETS 150 INDUSTRIAL d
WASTE APPROVAL Q
OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD V
0
V
W
d
N
Z
APPROVALS DATE INSPECTOR S SIGNATURE
PERMIT S 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 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 HOT WATER HEATER
PLUMBING
1 HEREBY CERTIFW
LY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUICOUNTY AND STATE OF GAS TEST
CALIFORNIA OR THANER OF AND IN NO TO
RESIDE IN THE ABOVTIA O Y UTILITY CO NOTIFIED
SIGNATUREJ
OF PERMITTEE I
FINAL
VALID0
CK M O CASH
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