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APPLICATION FOR PLUMSING- PERMIT .
COUNTY OF LOS ANGELES EX�OC
DEPARTMENT OF COUNTY ENGINEER �^
BUILDING AND SAFETY DIVISION BUILDINGt7JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS /f'
COLEMAN W. JENKINS, SUPT OF BUILDING ,- LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET $1.25 MAIL �7
BATH TUB 1.25
ADDRESS G/ '
SHOWER 1.25 CITY .` ,( e TEL.
LAVATORY 1.25 CONTRACTOR
SINE 1.25 ADDRESS i_7I
DISHWASHER 1.25 CITY �llTEL. NO 3 '
CONTRACTOR'S STATE ❑
LAUNDRY TUB 1.25 REGISTRATION NO. COUNTY ❑ "
CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE PRC
=SSED BY
WATER HEATER1.50 L
GAS SYSTEM_,(//�OUTLETS 1.50 INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD
L�
C=
NUJ
APP R�V/SLS DATE INSPECTOR'S SIG(JA?PUR�,
PERMIT s 2 00 UNDER%LXB WORK ®06 ; �?-i t j/
ROUGH PLUMBING
TOTAL FEE .}` r'. GAS PIPING .
;y I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING '„ HOT WATER HEATER
PLUMBING.
IPI I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
IA LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ` GAS TEST /
•1 CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO iL
RESIDE IN,THE ABOVE DESCRIBED RESID NTIAL PROPERTY. UTILITY CO. NOTIFIED
SIGNATURE 9 ' /yam•
OF PERMITTEE �--^- aZ
FINAL
VALIDATION ._)ROBERT A. WOOD
CK. M.O. CASH SUPERVISING MECHANICAL ENG'R
CUT 4 5 P, 2 0.5 v
I V�