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APPLICATION FOR PLUMBING PERMIT \
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER UCROSS
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BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER -42/21
WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY L/
FOR APPLICANT TO FILL IN
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET $1.25 MAIL
BATH TUB 1.25 ADDRESS
SHOWER 1.25 CITY TEL. NO.
LAVATORY 1.25 CONTRACTOR C
SING 1.25 )
ADDRESS y
DISHWASHER 1.25 s ( CITY TEL. NO.
CONTRACTOR'S STATE LAUNDRY TUB 1.25 REGISTRATION NO. COUNTY p
CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE PI Eb BY
WATER HEATER 1.50
GAS SYSTEM OUTLETS 1,50 INDUSTRIAL o_
WASTE APPROVAL O
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD V
O
H
UJ
W
O.
N
Z
APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT 5 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE , ' 'y '� GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS A PLICATION 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.
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT i AM THE LEGAL OWNER OF,AND INTEND TO
RESIDE IN, THE ABOVE DES RIBED RESIDENTIAL PROPERTY. UTILITY CO. NOTIFIED
SIGNATURE
OF PERMITTEE / --�
FINAL
VALIDATION ROBERT A. WOOD
CK. M.O. (SASH SUPERVISING MECHANICAL ENG'R
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