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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION RUILDING
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS NIS S� QJj .
WILLIAM A.JENSEN, SOFT OF BUILDING
LOCALITY � tT9YLlC%I
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE OWNER
WATER CLOSET $L25
MAIL
BATH TUB 1,25 ADDRESS
SHOWER 1.25 f CITY SEL. NO.
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LAVATORY 1,25 l CONTRACTOH��
SIN% 1.25 ADDRESS 3 Z c z A/ 13L dL�
DISHWASHER 1.25 CITY r ,v '/TEL. NO.
LAUNDRY TUB L25 CONTRACTOR',REGIS RA IONS NO. ��,J Zpj 7 COUNTY [ClSTATE
CLOTHES WASHER 1.25 DISTRICT NO. Qa2UP HONE P E ED BY
WATER HEATER 1.50
GAS SYSTEM OUTLETS 1.50 INDUSTRIAL y
WASTE APPROVAL O
OUTLETS OVER 5 PER SYSTEM .00 / / INSPECTION RECORD U
1
Z
APPROVALS DATE INSPECTOR5 SIGNATURE
PERMIT S 2 OO UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE57 GAS PIPING
HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS PLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND A E TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING T WA R HEATER
PLUMBING. , / �• n�n////�//Tl
1 HEREBY CERTIFY THMTREGIS D ANDIOR M�RES
LICENSED A5 REOUIRUNTY A D STATE OF GAS TESTCALIFORNIA OR TN 1R O O INTEND TOfl I HE IN,THE AB P aTv. UTILITY CO. NOTIFIEDSIGNATURE
OF PERMI E FINAL X Yl ./ -2
VALIDATION ROBERT A�WOODV
c�. M.0. CASH SUPERVISING MECHANICAL ENG'R
5 S 7 :i Z2 JUL j 5 D 3.2-5,
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