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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES u
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FNEAREST
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A. JENSEN, SUPT OF BUILDING
FOR APPLICANT TO FILL IN
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET 31.25 MAIL
BATH TUB 1.25 ADDRESS
SHOWER 1.25 CITY TEL. NO.
LAVATORY 1.25 CONTRACTOR
SINK 1.25 ADDRESS G•
DISHWASHER 1.25 CITYI TEL. NO. TQ 9(
LAUNDRY TUB 1.25 CONTRACTOR'S STATE
REGISTRATION NO. COUNTY
CLOTHES WASHER 1.25 DISTRI T N GROUP ZONE P E SED BY
WATER HEATER 1.50 `11)
GAS SYSTEM___L_OUTLETS 1'50 INDUSTRIAL a
WASTE APPROVAL O
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD U
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bV APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT 3 2 00 UNDER SLAB WORK
Q ROUGH PLUMBING
TOTAL FEE
11 GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION 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.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES ,.
LICENSED AS REQUIRED BY LOS ANGELES COUNTY ANO STATE OF GAS TEST ® ,,� 11
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO p ".( �".
RESIDE IN,THE ABOVE DESCRIBED RESIDENTIAL ROPERTY. UTILITY CO. NOTIFIED r' Y T�
SIGNATURE
OF PERMITTEE BB
FINAL
LIDATION ROBERT AV WOOD
cK.
M.0. CASH SUPERVISING MECHANICAL ENG'R
3293 HUG2�, 5 D 6.0(�- IN