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APPLICATION FOR PLUMBING .PERMIT
COUNTY' OF LOS ANGELES
DEPARTMENT.OF COUNTY ENGINEER
BUILDING AND. SAFETY DMSION- TUDID �s
JOHN.A.L"AMBIE. COUNTY ENGINEER O3
WILLIAM A:,JENSEN,SUPT OF BUILDING
� I e1 may..
FOR APPLICANT TO FILL IN NUMBER f FIXTURE OR ITEM EACH FEE
:WATER CLOSET 11.25 b.
,RATH'TUB 1.25 .. O ADDRESS
�• r CITY TEL. NO..
SHOWER- 1.25; �' '� _ •
�7 CONTRACTOR
cf LAVATORY 1:25
SINS 1.25 / ADDRESS
DISHWASHER .1.25CITY a TEL. NO:
LAUNDRY TUB. 1.25• CONTRACTOR'S' STATE
REGISTRATION NO.A�o Jyo COUNTY
CLOTHES WASHER 1.25 oZ.Y DISTRI NO GROUP ZONE. PROCE¢ Y
WATER HEATER 1.50
GAS SYSTEM OUTLETS
1.50 INDUSTRIAL
JPO WASTE APPROVAL .
OUIZETS OVER 5 PER SYSTEM .30 INSPECTION RECORDS / n
4/.:•tea I "A,
_ 8
. f v � y r r
4 0, Iv
S 1.7•. 'P�� it 1A
.� APP OVALS' DATE] INSPECTOJYS SI_Q „T RE
PERMIT __ $ 2 OO • UNDER:SLAB WORK rd�g
' .e� ROUGH PLUMBING
TOTAL FEE 2� GAS PIPING y�` •4r "
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
AND'STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY. '
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. HOT WATER HEATER _ '¢
I HEREBY CERTIFY THAT 1 AM 'PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE :OF GAS TEST
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF.,AND INTEND TO
RESIDE IN,THE ABOVE DESCRIBED'RESIDE L PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE
OF PERMITTEE
FINAL
GINNIE
ALIDATION ROBERT A.WOOD
cK. M.O: CASH SUPERVISING MECHANICAL ENG'R
OO-:6 9 Eta SEP 26. 5 D 16 2!-5