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76A667 CE#617 2-62
APPLICATION FOR PLUMBI G PERMIT
COUNTY OF LOS ANGELES �5-30 a�
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION F
G
JOHN A LAMBIE. COUNTY ENGINEER - '
WILLIAM A JENSEN SUP T OF BUILDING
Y
FOR APPLICANT TO FILL IN
T.
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET $1.25 MAIL
BATH TUB 1 25 / l ADDRESS
SHOWER 1.25 ZS CITY TEL NO ,
LAVATORY 125 V CONTRACTOR
SINK 125 ADDRESS
DISHWASHER 1 25 CITY f TEL. NO _
CONTRACTOR'srJ STATE
LAUNDRY TUB 125
REGISTRATION NO / y l COUNTY ❑
CLOTHES WASHER 1 25 Z DISTR NO GROUP Z N PR CESS o B
WATER HEATER 1 50 J'c7
GAS SYSTEM OUTLETS 1 5017—0 INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD
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�"� �� ..� ^1 l-�'�Yi^••, .`-"A''"L,:3ka.i:!, �P� to
' A&P_ROVALS DATE INSPECTOR S Sf; ATEURE
PERMIT $ 2 00 UNDERtLA9 WORK
ROUGH PLUMBING
TOTAL FEE 1,5- O Q GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION Id/
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT d
A I
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES r
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO /�f
RESIDE IN,THE ABOVE DESCRIBE ESIDENTIAL PROPERTY UTILITY CO NOTIFIED _
SIGNATURE
OF PERMITTEE ' /1 CA
FINAL !/
ALIDATION,. ROBERT A"WOOD
CK M O CASH SUPERVISING MECHANICAL ENG R
LACO6s441 NOV13 5 D 1 5.00