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76A 887 -CE#817 10-82
APPLICATION FOR PLUMBING PERMIT ,
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION nDD D N y�Q
JOHN A LAMBIE, COUNTY ENGINEER
WILLIAM A JENSEN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
2 WATER CLOSET $1.25 2 S0 MAIL
I BATH TUB 1.25 I z ADDRESS
�
SHOWER 1.25
r CITY TEL. NO.� ZJ•
LAVATORY 1.25 'L CONTRACTOR _ s +7—e C
f SINK 1.25 1 is- ADDRESS If 3321 L
' DISHWASHER 1.25 s- CITY TEL. NO. ")
LAUNDRY TUB 1.25 CONTRACTOR'S �+ r; �/ STATE
a- ❑
REGISTRATION NO. �J J / COUNTY ❑
CLOTHES WASHER 1.25 Z.J DISTRI T NO' GROUP ZONE, P SSED BY
WATER HEATER 1.50 SO Cjj�
S__
1.50
GAS SYSTEM J OUTLETS j S0 INDUSTRIALWASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD A V
09
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APPhR&Alj_S- PATE INSPECTOR'SSIGN.ATURE
UNDER.§bAB WORK 11(1 4/W _
PERMIT S 2 00
ROUGH PLUMBING
TOTAL FEE GAS PIPING - 4.
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS PPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER / 5
PLUMBING
IHEREBY 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 THE LEGAL OWNER OF,AND INTEND TO
RESIDE IN,THE ABOVE DESCRIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED
SIGNATURE i
OF PERMITTEEI(7! IAl
FINAL T- �
VALIDATION ROBERT A WOOD
_K M o ASH SUPERVISING MECHANICAL ENG'R
Lko 6 2 4 9- NOV 2 7 .5 D 1 6.251%,