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'bAi E#817 10-62 �
APPLICATION FOR PLUMBING P RMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION 7NEAREST
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A. JENSEN, SUPT of BUILDING
�7L
FOR APPLICANT TO FILL IN 17
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET $1.25 _ MAILS y
J BATH TUB 1.25 / L 1 ADDRESS
SHOWER 1.25 /�. L CITY TEL. NO.
LAVATORY 1.25 " ✓ CONTRACTOR
SINK 1.25 l 2- ADDRESS
DISHWASHER 1.25 CITY � TEL. NO. (i Cj �wCa
LAUNDRY TUB 1.25 CONTRACTOR'S � STATE
REGISTRATION NO. COUNTY ❑
i CLOTHES WASHER 1.25
D1=TRIGCT� GR To E P OEPP
F.0 BY
WATER HEATER 1.50
GAS SYSTEM �' OUTLETS 1.50 5 Z INDUSTRIAL d
WASTE APPROVAL 0
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD V
OC
W
CL
V1
Z
APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE
GAS PIPING
I 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.
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED Y LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT A THE LEGAL OWNER OF,AND INTEND TO -
RESIDE IN, THE ABOVE DES RIB /D //
j�RESIgP7'�TIAL PROPERTY. UTILITY CO. NOTIFIED
SIGNATURE
OF
IOF PERM TTEE
FINAL
/'VjALIDATION ROBERT A. WOOD
M.0. GASH SUPERVISING MECHANICAL ENG•R
Uwo 2 7 6 2:o AUG 18 5 D 15.00- 14