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:1PPLICATION FOR PLUMBING PERMIT � ..
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING 10(wG1 C. d9Qi11QA
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NCROSS EARESST. .. y y .J 1 .v
NUMBER FIXTURE OR ITEM EACH FEE OWNER ,f1. ib. gUtt ,�OAd
WATER CLOSET $1.25 Z AY r�'rYnU yy bat
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BATHTUB 1,25 ADDMAIRESS 5240 Pat IIat �/
SHOWER 1.25 Z CITY j [�y TELL. NO. �y-3539
LAVATORY 1,25 1 �. CONTRACTOR
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SINK 1.25 ADDRESS1461 / C. ULamna fAvd.
DISHWASHER 1.25 CI TYQ(jjdUt• & 63CL/I}2 TEL. N fd 8112
CTORSLAUNDRY TUB 1.25 EGINS� STATE
ON NO. ' 197747 7 COUNTY
CLOTHES WASHER 1.25 DISTRICT NOGROUP ZONE P O ESBED BY �
WATER HEATER 1.50 70 . ��- i[ _
/ GAS SYSTEM OUTLETS 1.50 (J'' INDUSTRIAL i
WASTE APPROVAL O
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD V
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APPROVALS DATE INSPECTORS SIGNATURE
PERMIT S 2 00 UNDER SLAB WORK
ROUGH PLUMBING ,1
]N A 4 A t _
TOTAL FEE
GAS PIPING
HERESY ACRN TH LEDGE THAT I HAVE READ THISGRE APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS LAND S AND AGREE E COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
I NEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ~�
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF. INT D TO GAS TEST
RESIDE IN,THE ABOVE DESCRI REBID TIAL P E UTILITY CO: NOTIFIED A
SIGNATURE
OF PERMITT
,FINAL //9kj
�LIDATION ROBERT A. WOOD
cR. M.O. CASH SUPERVISING MECHANICAL ENG'R
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