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76A667.CE#617 4-64
APPLICATION FOR PLUMBING PERMIT
qi COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION Anne
JOHN A.LAMBIE. COUNTY ENGINEER
WILLIAM A.JENSEN,SUPT OF BUILDING .LOCALITY
FOR APPLICANT TO FILL IN CROBS i. '
NUMBER FIXTURE OR ITEM EACH FEE OWNER
WATER CLOSET $1.25 MAIL r
BATH TUB 1.25 ADDRESS. .
CITY ' TEL. NO. ...,..�
SHOWER 1.25
LAVATORY 1.25 CONTRACTOR
SINK 1.25 ADDRESS
DISHWASHER 1.25 CITY . NO.
EEAOII
LAUNDRY TUB 1.25 REGISTRATION NO. COUNTY ❑
CLOTHES WASHER 1.25 D18T _ NO. G UP N P SSED BY
WATER HEATER 1.50
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GAS SYSTEM OUTLETS
1.50 INDUSTRIAL
NDU S�AAPROVAL 0 .
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD V
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APPROVALS DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT $ 2 00
�l ROUGH PLUMBING
TOTAL FEE 7 GAS PIPING
I HEREBY ACKNOWL90GE THAT 1 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 HOT WATER HEATER .r
PLUMBING.
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED A9 REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST `
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO
RESIDE IN.THE ABOVE DESC BED RESIDENTIAL PR ERTY. ,UTILITY CO.NOTIFIED
SIGNATURE
OF PERMITTEE
FINAL G
LMATION ROBERT A.WOOD
CK.
M.0. CASH SUPERVISING MECHANICAL ENG'R
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