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APPUCATI®1 tl F®R LUMB G PERIVII� 0 II
COUNTY OF LOS ANGELES �J
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING l
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEARESTt g
CROSS ST. Cii
NUMBER FIXTURE OR ITEM EACH FEES OWNERC
WATER CLOSET $1.25 All
MAIL
BATH TUB 1.25 ADDRESS
SHOWER 1,25 CITY TEL. NO.
LAVATORY 1.25 CONTRACTOR k !-''T'i^0 p 1 1
SINK 1.25 f ADDRESS 416 Z. c- - K' -t
DISHWASHER, 1.25 ")ems^ CITY TEL. NO. % y
STATE '�.- l LIC j w
LAUNDRY TUB, 1�: 1.25 LICENSE NO. p ��J CLASS J(�
CLOTHES WASHER 1.25 7 5 DISTMCT NO GROUP
N ppm CT Y
j WATER,HEATER• 1.50 r
GAS SYSTEM —s— OUTLETS 1.50 j INDUSTRIAL >-
WASTE APPROVAL a.OUTLETS OVER 5 PER SYSTEM 30 O
INSPECTION RECORD
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N
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APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK A/IJAI,�
TOTAL FEE / ROUGH PLUMBING ' I S
S4 GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT / f'�[
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
e I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO GAS TEST
RESIDE IN,THE ABOVE DESCRIBED RESI N PROPERTY. UTILITY CO. NOTIFIED
SIGNATURE
OF PERMITTEE FINAL
LIDATION
CK. M.O. CASH
L&O 2 7 0 0,*Lc' IN 10 5 D 1 7.5 0 N �'