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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING M^
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS n.7,1,
Pal) n.7,1
WILLIAM A JENSEN, SUPT OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN NEARCROSST .
NUMBER FIXTURE OR ITEM EACH FEE
OWNER .
WATER CLOSET $1.25 ;j MAIL
,5 y'
BATH TUB 1.25 Zr✓ ADDRESS jj
SHOWER 1.25 CITY ��'m �!e r. z TEL NO. f 7 1 9.('
LAVATORY 1.25 CONTRACTOR cj P,-
SINK 1.25 r Zj ADDRESS
DISHWASHER 1.25 CITY TEL. NO.
LAUNDRY TUB 1.25• CONTRACTOR'S STATE El
REGISTRATION NO. COUNTY ❑
CLOTHES WASHER 1.25 DISTRICT N G P PR BY
WATER HEATER 1.50 > O '
INDUSTRIAL �I d
GAS SYSTEM -3 OUTLETS 1.50WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .30 INSPECTIO RECORD V
0
W
IL
H
APPROVALS sDATE INSPEC 'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK sar 'moo '
ROUGH PLUMBING q'�// ��w° �&�9•'O""�16.g
TOTAL FEE GAS PIPING v E
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION '
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT _
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING
1 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 I AM THE LEGAL OWNER OF,AND INTEND TO
RESIDE IN,THE ABOVE DESCRIBP RESIDENTIAL PROPERTY UTILITY CO NOTIFIED.
SIGNATURE Nd✓{�
OF PERMITTEE
`- - FINAL
VALIDATION ROBERT A WOOD
cK M o CASH SUPERVISING MECHANICAL ENG•R
L _9 7 2,3-ho' SEP 3 5 .D 1 $,.7 5 'v