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7SA667 -CE9817 0-64
APPLICATION FOR PLUMBIN PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING 96 y/ E', �ro �m
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
WILLIAM A. JENSEN. SUPT OF BUILDING LOCALITY Cr•
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
2 WATER CLOSET $1.25 a S O MAIL
2 BATH TUB 1.25 Z S� ADDRESS
SHOWER 1.25 CITY TEL. NO.
LAVATORY 1.25
3 7S CONTRACTOR Q r t h e W S
/ n
SINE 1.25 s^ ADDRESS //79
Sze GlUNQ /T✓P .
/ DISHWASHER 1.25 CITY COUl"a TEL. NO. `-166 3j
LAUNDRY TUB 1.25 CONTRACTORS
EOIN STNATION NO. Z �✓ 3 O COUSTATE
CLOTHES WASHER 1.25 I ZS DISTRICT NO. GROUP ZONE OCE D BY
t�
WATER HEATER 1.50 1150 E5, C21-
CAS SYSTEM OUTLETS I.50 SD INDUSTRIAL a
WASTE APPROVAL O
OUTLETS OVER 5 PER SYSTEM .30 y y p 1 INSPECTION RECORD _ _ U
•/ A Z
APPROVALS DATE INSPECTOg:S 51GNATV
PERMIT S 2 00 UNDER SI.A&WORK
ROUGH PLUMBING �
TOTAL FEE / /. �� GAS PIPING r
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY Ll:
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER I:.7 <7M� ,,Gq✓Y�
PLUMBING.
I HERESY CERTIFY THAT 1 AM PROPERLY REGISTERED ANDIOR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST 67 a-.�!� �A�
CALIFORNIA OR THAT I AM THE LEGAL OWNER F.AND INTEND TO _
RESIDE IN,THE ABOVE DESCRIBED RESIDENTIAL oPERTY. UTILITY CO. NOTIFIED
SIGNATURE 1
OF PERMITTEE FINAL J
ALIDATION ROBERT A. WOOD
CK. M.O. CASH SUPERVISING MECHANICAL ENG'R
7.50
Lt,i� 4205 7C 2 5D 1