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APPLICATION FOR - PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY
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FOR APPLICANT TO FILL IN ; NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET 11.25 o MAIL
BATH TUB 1.2S i aS ADDRESS
SHOWER 1,25 CITY TEL. NO.
CONTRACTOR c y
LAVATORY 1.25 j G �C
SINK 1.25 �JC', ADDRESS � � Ra)j_.tl'rt_ ry
DISHWASHER 1.25 CITY SEL. NO.s1X3�UO/
LAUNDRY TUB 1.25 CONTRACTOR'SSTATE
i COUNTY
El
NO. �� I
CLOTHES WASHER' 1.25 DISTRICT NO. GROUP ZONEPRICCESSED BY
f WATER HEATER 1.50 Jt_ G
1.50 sINDUSTRIAL
GAS SYSTEM 16OUTLETS JWASTE APPROVAL }o
O
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD V
'1-(--W__ %t�y t_ E.. CZ b T O
Z
APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT S 2 00 UNDER SLAB WORK
_ ROUGH PLUMBING
TOTAL FEE S D O GAS PIPING IOaG
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING. /�
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES U
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST �p A
CALIFORNIA OR THAT I AM THE E�GALDEOWNER OF,AND INTEND TO
RESIDE IN,THE ABOVE7!10 R SINTIAL PROPS Y. UTILITY CO. NOTIFIEDrolg b UPCr
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SIGNATURE
OF PERMITTEE .e�q ` `�f oA�1��/(.�E''R�-�'^�'
FINAL fI/�C�I
VAIIDATION ROBERT A. woos
M O CASH SUPERVISING MECHANICAL ENG'R
i A o 0 0 '2 7MAR 7 9 5 D 1 5.00-
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