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APPUCAT�ON FOR PLUMMNIG PERMIT
COUNTY. OF LOS ANGELES LJ
DEPARTMENT OF COUNTY' ENGINEER ,r °
BUILDING AND SAFETY DIVISION .BUILDING
ADDRESS l^ I
JOHN A. LAMBIE. COUNTY ENGINEER
WILLIAM A. JENSEN, SUPT OF.BUILDING .LOCALITY {
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FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FDTURE OR ITEM EACH FEE
OWNERpp
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WATER CLOSET 9:'25 3 C"L1 MAIL
Pi BATH TUB 1-H �� ADDRESS
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SHOWER 4.25 CITY D a �a.e�«�c TEL. NO.`ljj—/Ssl
LAVATORY -625 50 CONTRACTOR
\ SINK `1-n 1150 ADDRESS S
DISHWASHER 1,25 ' X5 CITY ff, p TEL. N04,1 3-0(NV
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LAUNDRY TUB tm REGISTRATION NO. � " ( I COUNTY .
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CLOTHES WASHER '9`£5 7 DISTRICT NO GROf ZO E PRO S D BY
WATER HEATER 1.50INDUSTR
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e fGAS SYSTEM SOUTLETS L50 ! (� WASTE AiAL PROVAL O
OUTLETS OVER S PER SYSTEM .30 INSPECTION RECORD U
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APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK — — "
ROUGH PLUMBING
TOTAL FEE 9 GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP LIGATION 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.
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES J
LICENSED AS REQUIRED BY LOS ANGELES COUNTY ANDSTATE OF GAS TEST I�
CALIFORNIA OR THAT i AM THE LEGAL OWNER OF,AND INTEND TO _ y
RESIDE IN, THE ABO DES IBED RESIDENTIAL PROPERTY. a UTILITY CO. NOTIFIED -r
- SIGNATURE
OF PERMITTEE - /
FINAL
VALIDATION ROBERT A. WOOD
K M.O. CASH SUPERVISING MECHANICAL ENG'R
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