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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING �y
BUILDING AND SAFETY DIVISION ADDRESS D u�
JOHN A. LAMBIE. COUNTY ENGINEER
WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY '
FOR APPLICANT TO FILL IN NEAREST
CROSS Si. ff
NUMBER FIXTURE OR ITEM EACH FEE2 y�
�y OWNER +-s
qG. WATER CLOSET $1.25 ;E- J MAIL
r BATH TUB 1.25 ;L5 ADDRESS
SHOWER 1.25 Aff
CITY TEL. NO.
LAVATORY 1.25 7 CONTRACTOR
SINK 1,25 ADDRESS
DISHWASHER 1.25 CITY TEL. NO. -�
LAUNDRY TUB 1.25 CONTRACTOR'S STATE
REGISTRATION NO. COUNTY p
CLOTHES WASHER 1.25 DISTRICT NO. GROUP ONE P CESSED BY
WATER HEATER 1.50
GAS SYSTEM4__ OUTLETS 1'50 S� INDUSTRIAL a
WASTE APPROVAL O
OUTLETS OVER 5 PER SYSTEM .90 INSPECTION RECORD U
O
N
w
CL
N I
Z
APPROVALS DATE INSPECTOR'S SIGNATOR
PERMIT S 2 00 UNDER SLAB WORK M
ROUGH PLUMBING
TOTAL FEE V� GAS PIPING
I 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 ip�-
CALIFORNIA OR THAT i AM THE LEGAL OWNER OF.AND INTEND TO GAS TEST Nor,
RESIDE IN, THE ABOVE GCRI RESIDENTIAL P ERTY.
UTILITY CO. NOTIFIED
SIGNATURE ,
OF PERMITTEE
FINAL
t- VALIDATION ROBERT A. WOOD
M.O. CASH SUPERVISING MECHANICAL ENG'R
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