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APPLICATION FOR LUMBING ERMIT
COUNTY OF LOS ANGELES
DEPARTNIENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING a
JOHN A. LAMBIE. COUNTY ENGINEER
WILLIAM A.JENSEN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEARESCROST
TT .
NUMBER FIXTURE OR ITEM EACH FEE OWNERit
WATER CLOSET $1.25
MAIL
BATH TUB 1.25 ADDRESS 6 '
SHOWER 1.25 CITY TEL. N
41
LAVATORY 1,25 CONTRACTOl
SINK 1.25 ADDRESS S3 3
DISHWASHER 1.25 CITY L. NO-_& ' 00
LAUNDRY TUB 1.25 CONTRACTOR'S STATE
REGISTRATION NO. G COUNTY ❑
CLOTHES WASHER 1.25 DISTR CT PJO. ROUP ZONE P SSED BY
WATER BEATER 1.50 1 a C-
d
GAS SYSTEM OUTLETS 1'� W SEA ROVAL 0
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD.; u
0
Of «:
5^}� APPROVALS DATE INSPECT 'S SIGINATURE
PERMIT $ 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE }-j- GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATIO
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLYN GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER y "•t
PLUMBING.
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES 'C'
LICENSED AS REQUIRED BY LO ANGELES COUNTY AND STATE OF GAS TEST - - - --'
CALIFORNIA OR THAT I AM T LEGAL OW OF,AND INTEND TO '
RLur
THE ABOVE DES ED RE9IDEN L PROPERTY,. UTILITY CO.NOTIFIED - "�
SE
MITTEE
FINAL
C�LIDATION
ROBERT A. WOOD
'
M.0. CASH SUPERVISING MECHANICAL ENG'R
5 D 7. 5`