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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING S16'
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JOHN A LAMBIE COUNTY ENGINEER ADDRESS V b O1
WILLIAM A JENSEN SUP T OF BUILDINGLi LOCALITY
FOR APPLICANT TO FILL IN NEAREST
AR SOSS Si
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
AO—
WATER CLOSET $1 25 MAIL
I BATH TUB 125 ADDRESS
I SHOWER 125 CITY TEL NO
LAVATORY 125 CONTRACTOR
SINK 1 25 ADDRESS (s S
DISHWASHER 1 25 CITY am mit TEL NO 4,,1(4,13
LAUNDRY TUB 125 CONTRACTOR SSTATE
REGISTRATION NO + COUNTY ❑
CLOTHES WASHER 12S DISTRICT N GROUP ZONE PRO ESSED BY
WATER HEATER 1 50 6' Q
1 SO INDUSTRIAL I CL
GAS SYSTEM OUTLETS WASTE APPROVAL O
OUTLETS OVER S PER SYSTE14 30 INSPECTION RECORD] u
o
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7 APPROVALS DATE, INSPECTORS SIGNATURE
PERMIT S 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 18 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER ��/r�Y�j��
PLUMBING �ry/
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES .(/ldA��xfe'P'l
LICENSED AS REQUIRED BY LOS ANGELES COUNTY ANO STATE OF GAS TEST 11�f,!.�. f=A
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO v
RESIDE IN THE ABOV ESCRI D RESIDENTIAL PROPERTY UTILITY CO NOTIFIED P L�g C9
SIGNATURE
OF PERMITTEE
FINAL ��'
/aALIDATION ROBERT A WOOD l
CK / M o CASH SUPERVISING MECHANICAL ENG R
LAL09 ,mull � D 16.25-