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76A 667.=C EIW61 7-10-62
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER f
UILDING
BUILDING AND SAFETY DIVISION ADDRESS fj
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A. JENSEN, SUPT OF BUILDING OCALITY
FOR APPLICANT TO FILL IN EARESTROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE /1
q OWNER
WATER CLOSET $1.25 6' MAIL
' BATH TUB 1.25 ADDRESS
1 SHOWER 1.25 CITY TEL. NO.
LAVATORY1.25 2 �� CONTRACTOR
SINK 1.25 ADDRESS 3 .�
DISHWASHER 1.25 CITY Lc TEL. NO.CONTCTOR'S STATE
LAUNDRY TUB 1.25 r� REG STRA ION NO. C' 6 3 `f / G COUNTY p
CLOTHES WASHER 1.25 DISTRICT O. GROUP ZONE P�.)G,ESSED BY
WATER HEATER 1.50 1 S�j
C
GAS SYSTEMOUTLETS 1.50 1 S INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD V
OC
�v s O
F
t
i
J
APPROVALS DATE INS ECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE C> GAS PIPING �a `
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT _
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING. .+ �
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES E, z.• c, 1
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF -
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO GAS TEST
RESIDE IN,THE ABOVE DESCRIBED RESIDENTIAL PROPER UTILITY CO. NOTIFIED
SIGNATURE
OF PERMITTEE
FINAL
,,'VALIDATION ROBERT A. WOOD
CK. M.O. CASH} SUPERVISING MECHANICAL ENG'R
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