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,APPLICATION FOR PLUMBIN PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE. COUNTY ENGINEER
COLEMAN W JENKINS SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS 3
NUMBER FIXTURE OR ITEM EACH FEE
,OWNER
WATER CLOSET $1.25 MAIL
BATHTUB 125 ADDRESS
SHOWER 125 f C> CITY
LAVATORY 125 CONTRACTOR
SINK 1.25 ADDRESS
DISHWASHER 1 25 CITY TEL
STATE LIC
LAUNDRY TUB 125 LICENSE NO CLASS
CLOTHES WASHER 1 25 DISTRICT NO G OU Z NE/ PR ESSED BY
WATER HEATER 1 50 S , o /�
/ CD
GAS SYSTEM OUTLETS 1.50 INDUSTRIAL
WASTE APPROVAL V
OUTLETS OVER 5 PER SYSTEM 90 INSPECTION RECORD
U
W
d
N
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APPROVALS ATE INSPECTOR S SIGNATURE
UNDER SLAB WORK (} -
PERMIT $ 00
ROUGH PLUMBING
TOTAL FEE GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS A 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 C IF THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED ASQABCRIBEOD
' Y LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA O THE LEGA OWNER OF,AND INTEND TO
RESIDE IN TH DEN Y UTILITY CO NOTIFIED
SIGNATUREOF PERM IT
FINAL
C 'ITTION JACK R. ALLEN
o CrAySH {]�yS/U�PERVISINpG�MECHANICAL�iENG'R.
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