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APPLICATION TION FOR PLUM�I PERMI
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COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING P��
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS V�
COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY 4r� l� C
FOR APPLICANT TO FILL IN NEARCROSS TT. Gf��
NUMBER FIXTURE OR ITEM EACH FEE OWNER
WATER CLOSET 81.25
IL
BATH TUB 1.25 ADDRESS t.5d"_- _
SHOWER 1.25 i CITY TEL. NO�-�L �`j��
LAVATORY 1.25 Z CONTRACTOR
SINK 1.25 ADDRESS
DISHWASHER 1.25 CITY TEL. NO.
STATE LIC
LAUNDRY TUB 1.25 LICENSE NO. CLASS
CLOTHES WASHER 1.25 DISTRICT NO. GROUP XCWF, I PR BSED BY
WATER HEATER 1.50
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GAS SYSTEM OUTLETS 1'50 WASTE APPROVAL 0
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD u
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APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT S 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT
AND 8TATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES /
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND 8TATE OF GAS TEST '
CALIFORNIA OR THAT I A HE LEG O ROP,AND INTEND TO '
RESIDE IN,THE ABOVE DE 1 D D ZPERTY. UTILITY CO.NOTIFIED r
SIGNATURE 41
OF PERMITTEE FINAL
VALIDATION
CK. M.O. CASH
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