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APPLICATION FOR PLUMBI G PERMI -
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
COLEMAN W. JENKINS. SUPT. OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN CROS SST.
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET $1.25 MAIL
BATH TUB 1.25 ADDRESS
SHOWER 1.25 CITY �L G TEL. NO
LAVATORY 1.25 CONTRACTOR,p
SING 1.25 j ADDRESS O llG ,,e 0,,0G
DISHWASHER 1.25 TEL. NO , e/Gyj,
STATE LIC
LAUNDRY TUB c 1.25 LICENSE NO, CLASS
` CLOTHES WASHER 1.25 DISTRICT NO G ZONE P ES Y
WATER HEATER 1.50
GAS SYSTEM .0- OUTLETS I.50 S� INDUSTRIAL a
WASTE APPROVAL O
OUTLETS OVER 5 PER SYSTEM .90 c.D
INSPECTION RECORD
T C. ed 1 �g�, o
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W
CIO)
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APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE GAS PIPING
P 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+.
I 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 T I AM T LEGAL OWNER AND INTEND TO 'L
RESIDE IN, THE T V I , DXRESID.NTI P O RTUTILITY CO. NOTIFIED
SIGNATUREOF PERMITT /
FINAL
�LIDATION ,JACK R. ALLEN
CK. M o CASH SUPERVISING MECHANICAL ENG'R.
I
Lo y 1 7. 8 - JUN 2 0 5' .D 7.25- 117