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APPLICATION FOR "PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FADDRESS
NG C�
JOHN A. LAMBIE. COUNTY ENGINEER 5I G7
.WILLIAM A. JENSEN, SUPT OF BUILDING ITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET $1.25 '56 MAIL
BATH TUB 1.25 % a ADDRESS
It SHOWER 1.25 q CITY TEL. NO. -
LAVATORY 1.25 30 CONTRACTOR
SINK 1.25 as [A65DDRESS DISHWASHER 1.25 [� J TEL. NO.'V-Y3 '-0oV
CONCTOR'SJ' STATE R-�
LAUNDRY TUB 1.25 REGIS RAi ON NO. '/ 1 4(� COUNTY ❑
CLOTHES WASHER 125 - �7 -� DISTRICT NO. GROUP'• ZONE PR G' SSED BY
WATER HEATER 1:50
OUTLETS 1.50 �'I) INDUSTRIAL CL
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I GAS SYSTEM T A
WASTE APPROVAL O
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD U
✓�y14-
IL
5 a ° APO$6,YA`LS D'AT€ INSPECTPR'S SIG A1jURE
PERMIT $ 2 00 UNDERoge"WORK ceGf��d
ROUGH PLUMBING
�I�
TOTAL FEE I So GAS PIPING W"2 .
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION Y GAS VENT 1
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER /
PLUMBING.
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO GAS TEST
RESIDE IN,THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO. NOTIFIED '� ^✓'
SIGNATURE
: OF PERMITTEEDA!��
FINAL
VALIDATION ROBERT A. WOOD
M.O. CASH SUPERVISING MECHANICAL ENG'R
o.,g 5, 0 4- MAY 2 9 5 D .1750