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APPL' KATION FOR`,PLIJ�MBING PERMIT.
COUNTY OF LOS ANGELES,
DEPARTMENT OF COUNTY'-ENGINEER
BUILDING AND SAFETY DMSION BUILDING °
3` JOHN A. LAM IE: COUNTY ENGINEER (ADDRESS
WILLIAM A JENSEN,,SUP'T OF BUILDING -- - '
LOCALITY-'
FOR APPLICANT TO PILL IN NEAREST
CROSS:ST.
NUMBER , FIXTURE OR ITEM EACH FEE -
r OWNER
WATER CLOSET S1.2S J O MAIL
BATH TUB 1.25 —AlADDRESS
'•CITY TEL'. NO.
SHOWER ,1.25
LAVATORY 1,25 O CONTRACTOR
SING ' 1,25 ADDRESS
DISHWASHER. 1.25 CITY TEL�NO: —007
LCONTRACTOR'S STATE
LAUNDRY TUB 1.25
j REGISTRATION NO. COUNTY ❑
CLOTH 1.25 ;r DISTRICT NO. S GROUP ZONE P CESSED BY
WATER HEATER 1.50 �' TRIAL CL
GAS SYSTEM OUTLETS 1'io �� WASTE APPROVAL 0
OUTLETS OVER 5 PER SYSTEM .30' U
INSPECTION RECORDUA
00,x--�.. z
4" o - r
�J ,APPROVALS DATE I SPEC
SIGNATURE/
PERMIT $ 2 00 UNDER SLAB WORK MAP `i�//7O/J
ROUGH PLUMBING „ An �I Le - •�
TOTAL FEE I GAS PIPING �`����� •����'
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT •rY
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
PLITH
UMBING ALL COUNTY ORDINANCES AND STATE LAWS REGULATING "HOT WATER HEATER
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND `PLUMBING FIXTURES
LICENSED,AS REQUIRED BY LOS ANGELES COUNTY�AND STATE OF
ti ALIFORNIA OR THAT 1 AM THE LEGAL OWNER'OF,AND INTEND TO NGAS TEST
RESIDE'IN;THE ABO DES ED RES DENTIAL PROPERTY .� ��-+S'I
'UTILITY CO NOTIFIED s� `' `,v�g. �y�
SIGNATURE
•. _
OF PERMITTEE r/.2FINAL '•q CJ Jvq, �_.-�/+ 0 - " •;
T/�ra •i '
A- ,,�LIDATION ROBERT A 'WOOD,,
CK
M.0 CASH SUPERVISING MECHANICAL ENG'R
Y .9s ,m11 5-,D ' 1625 '