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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING O O3
JOHN A. LAMBIE, COUNTY'ENG I NEER ADDRESS
WILLIAM A. JENSEN. SUPT OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS $T. I�r�
NUMBER FIXTURE ORITEMEACH FEE ±
OWNER
WATER CLOSET . $1.25 MAIL
BATH TUB 1,25 ADDRESS
SHOWER1 25 CITY TEL. NO.
LAVATORY 1.25 CONTRACTOR
SINK 125 ADDRESS
DISHWASHER1.25 Cl Z4EL. NO. -�Z3
LAUNDRY TUB 1.25 CO CTO STATE
REGISTRATI N NO. COUNTY ❑
CLOTHES WASHER 1.25 DISTRICT NO.. GROUP ZONE 'PROCESSED BY
WATER HEATER 1.50 15—
Or.
GAS SYSTEM—OUTLETS— L50 INDUSTRIAL WASTE APPROVAL L Q
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD
If
oog
I U pd F
APPROVALS DATE INSPECTOR's SIGNATURE
PERMIT S 2 00 UNDER SLAB WORK �yJ
ROUGH PLUMBING i/ lw
TOTAL FEE GAS PIPING .r
1 HEREBY ACKNOWLEDGE I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCE. AMD STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANDIOR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF. ND INTEND TO
RESIDE INS THE ABOVE.DESCq BEO RE IDENTIAL PRO irrr. 'UTILITY CO. NOTIFIED
SIGNATURE "
OF PERMITTEE FINAL
LIDATION ROBERT A. WOOD
cn.
M.0. CASH SUPERVISING MECHANICAL ENG'R
LA(2 9' 1 3 G� AUG 21 ' 5 D 5.7 5IN