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APPLICATION FOR PLUMB G PERMI
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FNEAREST
ILDING
JOHN A LAMBIE COUNTY ENGINEER DRESS n
COLEMAN W JENKINS SUP T OF BUILDING CALITY ~r
FOR APPLICANT TO FILL IN CROSS T
NUMBER FIXTURE OR ITEM EACH FEE Q
OWNER
WATER CLOSET $1 25 MAIL
BATH TUB 125 ADDRESS
SHOWER 125 CITY TE NO
CONTRACTOR _
LAVATORY 125 �
SADDRESS
INK 1 25 `
DISHWASHER 1 25 CITY , TEL NOSTATE LIC
LAUNDRY TUB 125 Z<HLICENSE NO CLASS v
CLOTHES WASHER 125 DISTRICT NO GR E BY
WATER HEATER 150 / G2�
GAS SYSTEM OUTLETS 150 INDUSTRIAL a
WASTE APPROVAL 0
OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD U
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F-
U
W
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APPROVALS DATE INSPECTOR S SIGNATURE
PERMIT S 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE 12, GAS PIPING
I HEREBY ACKNOWLEDGE THAT I 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 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 DESCRIBED RESIDENT L ROPERTY UTILITY CO NOTIFIED
SIGNATURE
OF PERMITTE CC��
FINAL
LIDATION
CK M 0 CASH