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APPLICATION FOR PLUMBING PERM"
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING
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JOHN A. LAMBIE. COUNTY ENGINEER ADDp
WILLIAM A JENSEN, SUP'T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEARSTCROSS T. I�
NUMBER FIXTURE OR ITEM EACH FEE
WATER CLOSET $1.25 OWNER MAIL _17 a
S`C R y /V/��/�
BATH TUB 1.25 ADDRESS 9;6-1* oL �� �✓
SHOWER 1,25 CITY M lr�l X TEL. NO.
LAVATORY 1,25 CONTRACTOR PpUIV�)e
SINS 1.25 ADDRESS
DISHWASHER 1.2S CITY TEL. NO.
CONTRACTOR'S STATE
/ LAUNDRY TUB 1.25 REGISTRATION NO. COUNTY
CLOTHES WASHER 1.25 DISTRICT NO GR P ENEWD
WATER HEATER 1.50 o
GAS SYSTEM OUTLETS 1.50 INDUSTRIAL a
WASTE APPROVAL O
OUTLETS OVER S PER SYSTEM .$0 INSPECTION RECORD V
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V
W
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APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK J �'
ROUGH PLUMBING
TOTAL FEE GAS PIPING
[ANI HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT / V
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
H ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER I
MBING
HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
ENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
IFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO
IDE IN,THE ABOVE DESCRIBED RE ENTIAL PROPERTY UTILITY CO NOTIFIED
NATURE��F PERMIT ff��E_
FINAL
LIDATI ROBERT A�WOOD r
CK M o CASH SUPERVISING MECHANICAL ENG R
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