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APPLICATION FOR-. PI2UMI3 NG PERMIT` •
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING ®rc/
b JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
' WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY '
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER ' FIXTURE OR ITEM EACH FEE -
OWNER
WATER CLOSET 51.25 MAIL
BATH TUB 1.2S ADDRESS S L� G
SHOWER 125 CITY TEL. NO. oZ�
LAVATORY 1,25 ' CONTRACTOR
SING 1.25 ADDRESS
DISHWASHER 125 CITY TEL. NO.
LAUNDRY TUB 1.25 CONTRACTOR'S STATE �$
REGISTRATION NO.
S COUNTY []
CLOTHES WASHER 1.25 DISTRICT NO 'GROUP 7 NE PROCESSED BY
WATER HEATER L'r 7' 1.50 S , d
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GAS SYSTEM OUTLETS o_
1.50 INDUSTRIAL
WASTE APPROVAL O
OUTLETS OVERS PER SYSTEM .30 INSPECTION RECORD U
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APPROVALS DATE INSPECTOR S SIGNATURE
PERMIT S' Z 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE GAS PIPING `
I HEREBY ACKNOWLCDGE THAT,l HAVE READ THIS A PLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY 41
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING
I HEREBY CERTIFY THAT I ERLY R ISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY S ANGELES N Y AND STATE OF GAS TEST
CALIFORNIA OR THAT 1 THE LEGAL O ER�OF, N INTEND TO
RESIDE IN, THE ABOVE iCRIBED REBID TIAL PR v UTILITY CO NOTIFIED
SIGNATURE '
,OF PERMITTEE
FINAL 'LLI CA—
,
VALID, ROBERT A WOOD
CK M o CASH SUPERVISING MECHANICAL ENG;R
8 U. 4. 0-- APR 1 2 . 5 D
6.25--