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APPLICATION FOR PLUMBING .PERMIT
COUNTY OF LOS .ANGELES
DEPARTMENT OF COUNTY ENGINEER sc
BUWING AND SAFETY DMuuDlN
SION• UILDIN
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
WATER CLOSET $1.25 MAIL
BATH TUB 1.25 ADDRESS
SHOWER 1.25 CITY TEL. NO.
LAVATORY 1:25 CONTRACTOR
SINS 1:25 ADDRESS
DISHWASHER 1.25 CITYe. 92mglae� TEL. NO.6r 3d
CONTRACTORS STATE ❑
r
LAUNDRY TUB d.25 REGISTRATION NO. O(' 3 COUNTY ❑
CLOTHES WASHER. 1.25 DISTRIpT.
NO. GROUP ZONEESSED BY
WATER HEATER 1.50 I'
GAS SYSTEM OUTLETS 1.50 INDUSTRIAL CL
O
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .30. INSPECTIONRECORD U
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AP E,�AS - DATE INSPECTOR'S SIGNA�TUji,E
PERMIT 2 00 UNDER'.Ir'E�@ WORK 10,d j�/
ROUGH'PLUM.BING
TOTAL FEE 1 41 6� GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT _
AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY
WITH .ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. HOT WATER HEATER R.+��},•
-
1 HEREBY CERTIFY THAT I 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 ' /1 {�(.� ,'+fid✓�,�
RESIDE IN.THE ABOVE DESCRIBED RESIDENTIAL PERTY. UTILITY CO.NOTIFIED I�P�(� ,• l��.C.A,,�-/Q`,p,�,`„. f
SIGNATURE. I / !
OF PERMITTEE
FINAL � .
VALIDATI ROBERT Aj WOOD 'V
CK. M.o. (:::H)
CASH SUPERVISING MECHANICAL ENG'R
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2'1 7 2 AUG 4 -5 D 125 5 O N