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APPLICATION FOR PLUMBING�PERMI
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING. tc �
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS 4c�
WILLIAM A.JENSEN, SUPT OF BUILDING
LOCALITY e !/
FOR APPLICANT TO FILL INGROSS ST. Q
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET $1.25 MAIL
BATHTUB I. ADDRESS
SHOWER 1.25 CITY TEL. NO.
LAVATORY l 1,95 CONTRACTOR 0 L
SINK 1.25 ADDRESS ` �y
DISHWASHER 1.25 CITY 4 STEL. NO�p��� 7
LAUNDRY TUB 1.25. CONTRACTOR'S G �C STATE ❑
REGISTRATION NO. COUNTY
CLOTHES WASHER 1.25 �) DISTRICT NO.. G ZONE IPR C S BY
WATER HEATER 1.50
GAS SYSTEM OUTLETS "S0 � INDUSTRIAL O
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD U
CL
APP V DATE INSPECTOR'S SIGNATPRE
PERMIT 2 00 UNDER-SLAB WORK
ROUGH PLUMBING
TOTAL FEE GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP16LICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. HOT WATER HEATER
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES 'rs C_"� ;;p"s...tee.-t;,'�.:^•"•.,.
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 DES RIBED RESIDENTI ROPERTY. UTILITY CO.NOTIFIED
' SIGNATURE �£
OF PERMITTEE ,[
FINAL � L' a,
/ VALIDATION
ds
LIDATION ROBERT A. WOOD
CK.
M.0. CASH SUPERVISING MECHANICAL ENG'R
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