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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER.
BUILDING AND SAFETY DMSIONauILDINc
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS •(� Lll
WILLIAM A. JENSEN. SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN • NEARESBT.
NUMBER FIXTURE OR ITEM EACH FEE
CROSS WATER CLOSET $IRS MAIL
BATH TUB 1.25 ADDRESS
SHOWER LRS CITY TEL. NO.
�1
oV LAVATORY 1.25 CONTRACTOR
1 SINK 1.25 ADDRESS CLZCO-
DISHWASHER 1.25 CITY TEL. NO. yeI3`067
LAUNDRY TUB 1.25 CONTRACTO '8 STATE140
REGISTRATION NO. COUNTY ❑
/ CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE O EBBED BY
WATER HEATER 1.50 ,j dU L
r
GAS SYSTRM--j-- OUTLETS 1.50 INDUSTRIAL 0-
WASTE
WASTE APPROVAL O
OUTLETS OVER 5 PER SYSTEM .00 INSPECTION RECORD U
o
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3 -�• APPROVALS ^ DATE L UNI--CTOI'S SIGNATURE
PERMIT S 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE - -
GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE TNAT THE DI• CORRECT AND AGREE COMPLY GAS VENT
PLITH ALL UNGING, COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
I HEREBY CENT IFY THAT 1 AM PROPERLY REGISTERED ANO/OR PLUMBING FIXTURES z /
LICENSED AS REQUIRED BY LOS ANGELES COUNTY ANO STATE OF GAS TEST �Jr��/�:'�' ry,Q,r•�1
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND IWEND TO
RESIDE IN,THE ABOVE DESC ED RESIDENTIAL ROPERTY. UTILITY CO. NOTIFIED
SIGNATURE
OF PERMITTEE FINAL
VALIDATION ROBERT A. WOOD
1�,,/.J M.O. CASH SUPERVISING MECHANICAL ENG'R
�0 4 7 4- SEP23 5 D 15.0 0* v
2 _ p.