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APPLICATION FOR PLUMBIN . PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OFCOUNTY ENGINEER EBUILDING 10777
BUILDING ANDD SAFETY NI
JOHN A. LAMBIE. COUNTY ENGINEERNEER ADDRESS
WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST v
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET $1.25 MAIL c --
BATH TUB 1.25 ADDRESS/0777 C,
/ SHOWER 1.25 CITY TEL. NO.
LAVATORY 1.25 CONTRACTOR }
SINS 1.25 ADDRESS
DISHWASHER 1.25 CITY TEL. NO.1,1',ff 76191
LAUNDRY TUB 1.25 CONTRACTOR'S i9 �! STATE
REGISTRATION NO. COUNTY ❑
CLOTHES WASHER 1.25 DISrT NO. GROUP ZONE P OCES 13Y
WATER HEATER 1.50 JT
50 INDUSTRIAL
GAS SYSTEM_OUTLETS 1. WASTE APPROVAL O
OUTLETS OVER 5 PER SYSTEM' .30 V
INSPECTION RECORD
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14--P `" . O 6e <�
APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ '2 00 UNDER SLAB WORK
ROUGH PLUMBING
n 1..
TOTAL FEE GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS A LIGATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND THIS O COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST �L
CALIFORNIA OR THAT 1 AM THE LEGLOWNER OLADEND TO RESIDE IN,THE ABOVE CRIBED REPRUTILITY CO. NOTIFIED
SIGNATURE
OF PERMITTE
FINAL , Z/ � ��
ALIDATION ROBERT A. WOOD"
cK M O CASH SUPERVISING MECHANICAL ENG'R
WLAUD 0 7 8 11 SEP 2 7 5 D 7.25-