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APPUCATION FOR PtLU 2 SNC PE IT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN 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
qq OWNED
WATER CLOSET $1.25 f MAIL
BATH TUB 1.25 i. ADDRESS
SHOWER 1.25
CITY TEL. NO.
I �„
LAVATORY 1.25 CONTRACTOR
l SINK 1.25 ADDRESS
DISHWASHER 1.25 :L CITYTEL. NO. 7P-0b
Lic
LAUNDRY TUB 1.25 LICENSE NO. 23�— 7</� CLASS
CLOTHES WASHER 1.25 DISTRICT NO. GROUP PRO BY
WATER HEATER 1.50 S(�
GAS SYSTEM OUTLETS 1.50 Sv INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD d
A.
a
z
APPROVALS DATE ..t INSPE',Lq.ReS-SIGNATURE
PERMIT 5 2 00 UNDER SLAB WORK
e ROUGH PLUMBING
TOTAL FEE f,
GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT I �
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 REOUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO GAS TEST J2.7-@�.�y'� � Ian A
RESIDE IN,THE ABOVE SC D RESIDENTIAL PROPERTY. UTILITY CO.-NOTIFIED ! v A
SIGNATURE
OF PERMITTEE FINAL ,�` -,�nj O�r1D�19
ALIDATION JACK R. ALLEN
cK.
M.0. CASH SUPERVISING MECHANICAL ENG'R.
L10 0 9 59 1-0 SEP 2 9 5 D 1 6.2 5