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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION I BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS j
1 WILLIAM A. JENSEN, SUPT OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
caoss sr.
NUMBER FIXTURE OR ITEM EACH FEE
2 WATER CLOSET $1.25 ___7_
1.25nkil
1 BATH TUB 1.25 2 r ADDRESS
t SHOWER 1.25 CITY 1 TEL. NO.
LAVATORY 1.25 �—v CONTRACTOR
SINK 1.25 .� ADDRESS 3
DISHWASHER 1.25 CITY TEL. NO. -�� -73-74
Z
LAUNDRY TUB 1.25 REGISTRATION NO. Gra 6 1,33-9119 COUNTY
CLOTHES WASHER 1.25 Z 9 DISTRIC3 NO. GROUP ZONE PROCESSED BY
WATER HEATER 1.50 �► 7L:l A 11 64
CCI
GAS SYSTEMWASTE APPROVAL
OUTLETS 1.50 V INDUSTRIAL z
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD
0
Lu
W
O APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT S 2 00 UNDER SLAB WORK
OV ROUGH PLUMBING
TOTAL FEE
GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION --
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH
AL. COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER t
I 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
RESIDE IN,THE ABOVEDE CRIBED REST ENTIAL PROPERTY. UTILITY CO. NOTIFIED
SIGNATURE
OF PERMITTEE FINAL
��K''' LIDATION ROBERT A. WOOD
K. M. O. CASH SUPERVISING MECHANICAL ENG'R
A - D ri