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76A667-CE#017 6-65
APPLICATION FOR ,PLUMBI G PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A LAMBIE, COUNTY ENGINEER ADDRESS
COLEMAN W JENKINS SUPT OF BUILDING LOCALITY jgrPC01-0/ ¢
FOR APPLICANT TO FILL IN CROSS ST. 40
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NUMBER FIXTURE OR ITEM EACH FEE
WATER CLOSET $1.25 OWNER
MAIL
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BATH TUB 1.25 ADDRESSn G zo
SHOWER 1.25 CITY r C C/4 D TEL. NO. O 'Id
LAVATORY 1.25 CONTRACTOR L
SINK 1.25 ADDRESS
DISHWASHER 1.25 CITY TEL. NO.
STATE LIC
LAUNDRY TUB 1.25 LICENSE NO CLASS
CLOTHES WASHER 1.25 DISTRICT NO G Z�{IE 7;11 rF4BY
WATER HEATER 1.50
GAS SYSTEM OUTLETS
1.50 INDUSTRIAL
WASTE APPROVAL O
OUTLETS OVER 5 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 GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APP ICA ION 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 AND STATE OF GAS TEST
CALIFORNIA OR THAT 1 AM TME LEGAL OWNER OF, NO INTEND O
RESIDE IN, THE ABOV SCRIBED RESIDENTIAL PRO&RTY U I ITY CO NOTIFIED
SIGNATURE
OF PERMITTE FIAL (s Z
LIDATION
CK M O CASH
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76A667-CE817 6-60
APPLICATION) FOR PLUMBING PERMIT �
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
WILLIAM A. JENSEN. SUP !T OF BUILDING LOCALITY G CITY
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FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM OWNER
�j WATER CLOSET MAIL l•(JL
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CITY I l TEL. NO. -/
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SINK ADDRESS ,5 U
DISHWASHER
CITY 0 r 2/3 TEL NO. 7
STATE
LAUNDRY TUB REGISTRATION NO. Y`b
COUNTY
= CLOTHES WASHER DISTRICT NO. GROUP ZONE PRQCESSED BY
WATER HEATER ✓i
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
e INSPECTION RECORD
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OR ITEM
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APPROVALS DATE INSPECTOR'S SIGNATURE
PERMITI
2 00 UNDER SLAB WORK _
TOTAL FEE (�� ROUGH PLUMBING
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1 HEREBY ACKNOWLEDGE THAT 1 HAVEPPLICA710N GAS VENT
AND STATE THAT THE ABOVE IS CORRECTTO COMPLY
WITH ALL COUNTY ORDINANCES AND SREGULATING HOT WATER HEATER A
PLUMBING.
I HEREBY CERTIFY THAT 1 AM PROPERED AND/OR PLUMBING FIXTURES s�/[[���li/yI>/�P
LICENSED AS REQUIRED BY S ANGELESD STATE OF GAS TEST
CALIFORNIA OR THAT I AM THE LEGALTHE ABOVE ,
DESCRIBED RESIDENTIAL R ERTY. UTILITY CO NOTIFI I F "
SIGNATURE OF PERMITTEFINAL l
VALIDATION ROBERT A. WOOD. U v p
CK. M.O. CASH SUPERVISING MECHANICAL ENG'R
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