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76AS67 -CE#817 12-64
APPLICATION FOR PLUMBI G PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAM BIE, COUNTY ENGINEER rDDRESSCOLEMAN W. JENKINS, SUPT OF BUILDING CALITYFOR APPLICANT TO FILL IN ARESTOSS S
NUMBER FIXTURE OR ITEM EACH FEE
_ OWNER 7 c-' 14 -:
WATER CLOSET $1.25 J MAIL
BATH TUB 1.25 ' ,2 �� ADDRESS
SHOWER 1.25 sL1� CITY TEL. NO.
LAVATORY 1.25 '5c CONTRACTOR A t _ ft
SINK 1.25 ' 'j j ADDRESS
DISHWASHER 1.25 12). CITY �/, TEL. NO. 5 7 3-6 5 CV
CONTRACTOR'S STATE
LAUNDRY TUB 1.25 REGISTRATION NO. I, COUNTY ❑
CLOTHES WASHER 1.25 Z�1 DISTRICT NO.,/ GR�yL ;PE PgOCE BY
WATER HEATER 1.50 �O[ (//V�
50 INDUSTRIAL
GAS SYSTEM 1.
OUTLETS �J WASTE APPROVAL d
OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD 0 w
C9
0
w
W
IL
co
Z
APPROVALS IN E OR'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK �[
ROUGH PLUMBING
TOTAL FEE GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND 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
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO
III RESIDE IN,THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO. NOTIFIED -
SIGNATURE
OF PERMITTEE FINAL
CK
ROBERT A. WOOD
CK. M.O. CASH SUPERVISING MECHANICAL ENG'R
9553' FEB 10 5 D 1625- 14