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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING i1
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS vi
WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY •
FOR APPLICANT TO FILL IN NEARES
CROSST. P YYJ
° NUMBER FIXTURE OR ITEM EACH FEE /
OWNER
WATER CLOSET 51.2S MAIL
BATH TUB 1,2S S ADDRESS
SHOWER 1.25 CITY TEL. NO.
e
LAVATORY 1.25 CONTRACTOR
SINK 1.25 ADDRESS
DISHWASHER 1.25 CITY �� TEL. NQa
LAUNDRY TUB 1.25 CONTRA OR'S ST TE
REGISTRATION NO. COUNTY ❑
0
CLOTHES WASHER 1.25 DISTRICT NO. GRCYFJP ZONEPROCESSED BY
WATER HEATER 1.50 ��" ! /� C<: '
GAS SYSTEM - OUTLETS 1.50 INDUSTRIAL a
WASTE APPROVAL O
OUTLETS OVER S PER SYSTEM .30 INSPECTION RECORD V
cle
C I o
N
APP CDVA• DATE'/ INSPECTOR'S SIGNATURE
1 _RMIT $ 2 00 UNDER „ WORK
'B+7Cp
*-.14
MIT
ROUGH PLUMBING I r �'� k
TOTAL FEE u J 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 AT I NIP P RLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REOUI D BY L S A GE 5 UNTY AND STATE OF
CALIFORNIA OR T I M THE GA O �'/I OF,AND INTEND TO GAS TEST
RESIDE IN,THE A VE D CRIBED ES E (PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE ((l
OF PERMITT E
.,J. . . . 6 FINAL
.LIDATION ROBERT AWOOD
CK.` M.O. CASH SUPERVISING MECHANICAL ENG'R
l.t'Ii:o 1 2:v AUG 17 5 A 7.25