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APPLICATION FOR PLU �BING PE MIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER (�.
BUILDING AND SAFETY DIVISION FNEAREST
ULDNG
JOHN A. LAMBIE. COUNTY ENGINEER
WILLIAM A. JENSEN, SUPT OF BUILDING
FOR APPLICANT TO FILL IN CROSS ,2CJ
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET $1.25 L fj�
ADDRESS
BATH TUB 1.25 CITY �y TEL. N . ,��
SHOWER 1.25
LAVATORY 1.25 CONTRACT
SINE 1.25 ADDRESS_/O O ,.�� _
DISHWASHER 1.25 CITY J &4 TEL. NO.CONTRACTOR'ISZ STATE
LAUNDRY TUB 1.25 REGISTRATION NO. �/l COUNTY ❑
CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE PROCESSED BY
/
WATER HEATER 1.50
GAS SYSTEM OUTLETS 1.50 INDUSTRIAL O
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD V
O
F-
U
W
N
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APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 QO UNDER SLAB WORK
_ ROUGH PLUMBING
TOTAL FEE � � e GAS PIPING
s
LANA BY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT Q ^
TE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY A h
LL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATERGEBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURESD AS REQUIRED BY LOS ANGELES COUNTY AND STATE OFGAS TESTNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TON, THE ABOVE DESCR D NTIAL ROPERTY. UTILITY CO. NOTIFIEDURERMITTEE FINAL
VALIDATION ROBERT A WOOD V
CK M o CASH SUPERVISING MECHANICAL ENG'R
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