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APPLICATION FO PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OFD COUNTY ENGINEER BUILDING ? �
BUILDING AND SAFETY DIVISION J
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS ..
WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY y Ci
FOR APPLICANT TO FILL IN NEAREST
NUMBER FIXTURE OR ITEM EACH FEE �L
OWNER ✓✓
WATER CLOSET $1.25 j� MAIL
i
I BATH TUB 1.25 ! = f ADDRESS
SHOWER 1.25 CITY TEL. NO.
LAVATORY 1.25 Z ) CONTRACTOR, �C
( SINK 1.25 J ADDRESS 7
DISHWASHER 1,25 CITY � // TEL. NO.CONTRACTOR'SrYL
STATE
LAUNDRY TUB 1.25 REGISTRATION NO. 4 �' c� COUNTY ❑
CLOTHES WASHER 1.25 �'S DISTRICTO. GROUP ZONE ESSED BY
WATER HEATER 1.50 S�D
GAS SYSTEM 5 OUTLETS 1,50 S Z INDUSTRIAL d
WASTE APPROVAL O
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD V
O
I �
Lu
C y� APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
TOTAL FEE
ROUGH PLUMBING
1 %�
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
PLUMBING. HR
HOT WATER EATE
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES 1
LICENSED AS REQUIRED LOS ANGELES COUNTY AND STATE OF GASTEST _
CALIFORNIA OR THAT I M THE LEGAL OWNER OF,AND INTEND TO
RESIDE,IN,THE ABOVE S RIBED RESIDENTIAL PROPERTY. UTILITY CO. NOTIFIED _
SIGNATURE
OF PERMITTEE FINAL CJ
LIDATION ROBERT A. WOOD
cK. M.o. CASH SUPERVISING MECHANICAL ENG'R