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r APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS 4�Z j
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 0 MAIL
BATH TUB 1,25 If 2 v ADDRESS
J SHOWER 1.25 t 2, CITY TEL. NO.
LAVATORY 1.25 2 CONTRACTOR
SINK 1.25 25— ADDRESS
DISHWASHER 1.25 CITY t3 I TEL. NO. Ed 737 g
LAUNDRY TUB 1.25 CONTRACTOR'S STATE
REGISTRATION NO. C`3 G 13 34/b COUNTY
CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE P SSED BY
WATER HEATER 1.50 `j
GAS SYSTEM OUTLETS 1.50 1> INDUSTRIAL
WASTE APPROVAL O
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD V
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U/I APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 BO{0 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE /5- 400
GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANO/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO GAS TEST
RESIDE IN,THE ABOVE DESCRIBED RESIDENT AL PROPERT UTILITY CO. NOTIFIED
SIGNATURE '
OF PERMITTEE
FINAL
c\ ALIDATION ROBERT A. WOOD
M.O. CASH SUPERVISING MECHANICAL ENG'R