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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
WILLIAM A JENSEN SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET Sl O MAIL
BATH TUB 125 ADDRESS
SHOWER 125 CITY TEL NO
LAVATORY 125 CONTRACTO ~
SING 125 ADDRESS
DISHWASHER 125 CITY TEL -77
ATE
LAUNDRY TUB 1 25 REGISTRATION NO 11'CTOR Sa COUNTY ❑
CLOTHES WASHER 1 25 DISTRICT NO GRQLWI Z E PRO SED BY
WATER HEATER 1 50 Q
GAS SYSTEM OUTLETS 1 50 WASTE INDUSTRIAL O
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD V
GC
0
I-
U
W
d
N
Z
APPROVALS DATE INSP TOR S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK i I'll `i
ROUGH PLUMBING .�
TOTAL FEE D(J GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION -�
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT _
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER `��,
PLUMBING
1 HEREBY CERTIFY THAT-I 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 RESIDENTIAL PROPERTY UTILITY CO NOTIFIED
SIGNATURE
OF PERMITTEE FINAL fi � '6,''l
VALIDATION ROBERT A'WOOD
cK M o CASH SUPERVISING MECHANICAL ENG R
L;lro 2 6 1 7 :,AR 2 8 5 D
1500-