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APPLICATION FOR PLLUMEIN _ PERMIT
COUNTY OF LOS ANGELES J�
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING !TE
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST. U_,PNUMBER FIXTURE OR ITEM EACH FEEWAER CLOSET $1.25 sMAIL
BATH TUB 1.25 9s ADDRESS
SHOWER 12SCITY NO.
LAVATORY - 1.25 c- , CONTRACTORSINK 1.25ADDRESSDISHWASHER 1.25 CITY NO. ZglZ/3 --o 0 X
LAUNDRY TUB 1.25 CONTRACTOR'S STATE
REGISTRATION NO. 7 COUNTY p
CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE P OCE D BY
f WATER HEATER 1.50 J-0DUSTRIAL
S� }
GAS SYSTEM 17 OUTLETS "-a � J� WASE APPROVAL Q
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD
1 '-'4 ak _ r o
Lu
CL
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APPROVALS DATE �I PECT 'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK �6� a 0
ROUGH PLUMBING ^.)
TOTAL FEE 00 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 HEATER17 ✓
LRESIDE
CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
S REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO
HE ABOV DESC D RESIDENTIAL PROPERTY. UTILITY CO. NOTIFIED 0 C/E ,1 / DITTEE FINAL �r1914
LIDATION ROBERT AfWOOD
cK. M.o. CASH SUPERVISING MECHANICAL ENG'R
LAW 4 6 9 01 JAN21 21 5 D 1 5.0 0 M ft