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APPLICATION FOR PLUMBI G PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS C B.
WILLIAM A. JENSEN. SUPT of BUILDING LOCALITYil�rl
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE
OWNER IF
WATER CLOSET $1.25 , MAIL r�
BATH TUB 1.25 ADDRESS
CITY, ',c.. TEL. NO. �` O
SHOWER 1.25 /
LAVATORY 1.25 CONTRACTOR
/ SINK 1,25 ADDRESS
DISHWASHER 1.25 CITY TEL. NO.
LAUNDRY TUB 1.25 CONTRACTOR'S STATE ❑
REGISTRATION NO. COUNTY ❑
CLOTHES WASHER 1.25 rRI NQ,% GR ZONE o ga£p BY
WATER HEATER 1.50 Jame / `Jv
GAS SYSTEM OUTLETS 1.50 INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD Qom.
31 JIM
_A' V
W
N
APPROVALS QATE INSPECTOR'S SIGNATWRE
PERMIT $ 2 00 UNDER SLAB WORK
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 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 I AM THE LEGAL OWNER OF,AND INTEND TO
RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO. NOTIFIED
SIGNATURE f
OF PERMITTEE 0'""
FINAL
j �TALIDATION ROBERT A. WOOD
C;
M.J. CASH SUPERVISING MECHANICAL ENG'R
L-1 i�o 0 0 1 9 w JAN 2 2 5 a