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APPLICATION FOR PLUMBI G PERMIT
COUNTY OF LOS ANGELES E ,
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
WILLIAM A JENSEN, SUPT OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET $1.25 MAIL
BATH TUB 1.25 ADDRESS
SHOWER 1.25 CITY TEL. NO.
LAVATORY 1.25 CONTRACTO
_ SINK 1.25 ADDRES
DISHWASHER 1.25 CIT TEL. NO,&51:7 Q�
LTUB 1.25 COUNTY ❑
CONTRA ORS STATE
LAUNDRY
REGISTRATION NO. p2
CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE PR C SED BY
WATER HEATER 1.50 ` ( G( 2
GAS SYSTEM OUTLETS 1.50 INDUSTRIAL d
WASTE APPROVAL 0
OUTLETS OVER 5 PER SYSTEM .30 1 INSPECTION RECORD „ LJ
ULU
z
L136 Nikr A
71=14 3
APPROVALS DATE# INSPECT.OR'S 512 ATURE
PERMIT $ 2 00 UNDER SLAB WORK � lEJ/j
ROUGH PLUMBING
TOTAL FEE l� b GAS PIPINGjI
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT V
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY !.
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING J
HOT WATER HEATER
PLUMBING. •
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF !!/ ((J
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO GAS TEST (]%� v A:5
'RESIDE IN,THE ABOVE DESCRIBED R D INITIAL PROPERTY UTILITY CO NOTIFIED
SIGNATURE
OF PERMITTEE /�p •q.11"%
FINAL
ALIDATION ROBERT AWOOD
cK M o CASH SUPERVISING MECHANICAL ENG'R
t llo 6 7 5 0%-D' AIN 27j 5 D -1- 5 .0 0