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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
WILLIAM A JENSEN SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSS ST CtJ�_
NUMBER FIXTURE OR ITEM EACH F E
OWNER
2 WATER CLOSET $125 s 0 MAIL
HATH TUB 125 ADDRESS
SHOWER 125 CITY TEL NO
LAVATORY 125 5 CONTRACTOR °
SINS 125 o ADDRESS 1
DISHWASHER 125 CITY TEL NO
LAUNDRY TUB 125 CONTRACTOR STATE
REGISTRATION NO COUNTY
CLOTHES WASHER I DISTRICT GAUP I ;qE PR S BY
WATER HEATER 150 JOC
GAS SYSTEM OUTLETS 150 Oo Iyypg APPROVAL
OUTLETS OVER 5 PER SYSTEM 30 d
J INSPECTION RECORD ° O
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'AP ROVALS DATE INBPEGY;R S SIGNATURE
PERMIT 53 Z 00 UNDER SLAB WORK
^ ROUGH PLUMBIN T
TOTAL FEE GAS PIPING Y
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP (CATION GAS VENT
AND STATE 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 I AM PROPERLY REGISTERED AND/OR PLUMBING FIXT `
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST i g
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO _
RESIDE IN THE ABOVE DESCRIBED R IDENTIAL PROPERTY UTILITY CO N TIFIED
K
SIGNATURE _ e
OF PERMITTEE FINAL
CK J/ M ATION ROBERT A WOOD
CK / M o CASH SUPERVISING MECHANICAL ENG R
LOLL e 9 6 o" JUL D 5 D 1 P t._ 5 n