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APPLICATION FOR PLUM NG PER IT
COUNTY OF LOS ANGELES
DEPARTMENT OFD COUNTY ENGINEER BUILDING `/Z3
BUILDING AND SAFETY DIVISION ADDRESS J V L L. S D
JOHN A LAMBIE COUNTY ENGINEER
COLEMAN IN JENKINS SUP T OF BUILDING
LOCALITY '+ Ci7Y
FOR APPLICANT TO FILL IN NEAREST
ROSS sT L t 7
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET $125 MAIL
BATH TUB 1 25 ADDRESS SSS D
SHOWER 125 CITY P ']' TEL NO
LAVATORY 125 CONTRACTORL
SINK 125 1 Z ADDRESS Z U
DISHWASHER 1 25 I CITY P TiEL NO Z�6 76 I
10
LAUNDRY TUB 1 25 REGINSTRA ION NO 2 I � COiUNTY ATE O
CLOTHES WASHER 125 DIST CT O GROUP I ZONE PROISJESSED BY
WATER HEATER 150
1 50 INDUSTRIAL
GAS SYSTEM OUTLETS WASTE APPROVAL C
OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD v
C3
N2
IL
N
z
APPROVALS DATE INSPECTOR S SIGNATURE
PERMIT $ 2 OC UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE ,S� GAS PIPING % tv
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
LRFSIDE
COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
Y CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES , ��d�4� ` AlAoAw
AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
A OR THAT I AM THE LEGAL OWNER OF AND INTEND TO
THE ABOVE DESCRIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIEDREMITTEE FINAL
/'—VALIDATION ROBERT A WOOD -
cK M O CASH SUPERVISING MECHANICAL ENG R
LACO 6 9 2 91 OCT2 9 5 D 450-