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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, SUPT OF BUILDING LOCALITY C
FOR APPLICANT TO FILL IN NEAREST _
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET ;1.25 MAIL
BATH TUB 1.25 / ADDRESS
SHOWER 1.25 / CITY TEL. NO.
LAVATORY. 135 CONTRACTOR - nc.
SINE 1.2 — ADDRESS
DISHWASHER 1.25 CITY TEL. NO. ADD
LAUNDRY TUB 1.25 CONTRACTOR'SSTATE
REGISTRATION NO. lod COUNTY
r• CLOTHES WASHER 1.25 DISTRICT NO. GROUP /ZONE PR CESSEO BY
WATER HEATER 1.50 6 '! C /
GAS SYSTEM OUTLETS 1.50 INDUSTRIAL 0
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .20 NSPECTION RECORD U
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APAP OVAe S DATE INSPECTOR'S SIGNPTUREDATE INSPECTOR'S SIGNPTURE
PERMIT S 2 00 UNDEgWORK J 0 �0 /��WORK J 0 �0 i��I,%/
ROUGH PLUMBING LI/T I ��W)
TOTAL FEE ,O GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION �f
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. HOT WATER HEATER
7�><WL AI.a�Id✓/F
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTYAND STATE OF GAS TEST
CALIFORNIA ON THAT 1 AM THE LEGAL OWNER OF.AND INTEND TO I
RESIDE IN,THE ABOV OESCRIBEO RESIDENTIAL PR PERrr. UTILITY CO. NOTIFIED 2 �(Arj / Jf•//
SIGNATURE 7/ /� I
OF PERMITTEE
_ FINAL
• /-VALIDATION ROBERT Ar WOOD
M.0. CAS. SUPERVISING MECHANICAL ENG'R
LC07 9 4 9'G JAN 2? 5 D 1 6.25-