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APPLICATION OOR PLU BING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING �a wJOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
COLEMAN W. JENKINS. SUPT. OF BUILDING
LOCALITY -
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE OWNER
WATER"CLOSET $1.25 �
BATH TUB 1.25
AD
BATH /d ? � +
SHOWER 1.25 CITY TEL. NO +"`Ly
LAVATORY 1.25 CONTRAC
SIN% 1.25 ADDRESS
DISHWASHER 1.25 CITY TEL. NO.
STATE O LIC
LAUNDRY TUB 1.25 LICENSE O. /�2. CLASS
CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE P OCE$S D BY
WATER HEATER 1.50 4
1.50 INDUSTRIAL
GAS SYSTEM OUTLETS WASTE APPROVAL p
OUTLgTS OVER 5 PER SYSTEM .30 a r&qINSPECTION RECORD U
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APPROVALS ' DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE GAS PIPING
1 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 I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY,LOS AN LES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT I A 'THE L AL OWNER OF,AND INTEND T
RESIDE IN,THE ABOVE DE RISE RESIDEN PR.BERT UTILITY CO.NOTIFIED
SIGNATURE
OF PERMITTEE / , FINAL r �'�'/',�^?,• ,a �� �ly ��.i_:
LIDATIQ JACK R.'ALLEN
M.O. (` CASH/) SUPERVISING MECHANICAL ENG'R.
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