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APPLICATION FOR �LUMB G PERMI
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIMS= BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
COLEMAN W. JENKINS,SUP'T OF BUILDING, LOCALITY
FOR APPLICANT TO FILL IN NEAREST
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET 51.25
MAIL
BATH TUB 1.25 ADDRESS
CITY r TEL. NO.
SHOWER 1.25
LAVATORY 1.25 CONTRACTOR
SINS 1.25 .e ADDRESS
DISHWASHER 1.25 CITY TEL. NO.
LAUNDRY TUB 1.25 CONTRACTOR'S STATE E3REGISTRATION NO. COUNTY ❑
CLOTHES WASHER 1.25 X
v DIST ICT NO. G—�PZONE 17MY
WATER HEATER 1.50oJ
GAS SYSTEM OUTLETS 1.50 O INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .30 INS . CTION RECOR
IH
Z
APPROVALS D/lTE, 1 P -OR'S SIGNATURE
PERMIT 5 2 00
UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE GAS PIPING
1 NEREBY 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 HOT WATER HEATER
PLUMBING.
1 HEREBY CERTIFY THAT I 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 1t
RESIDE IN.THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED P
SIGNATURE
Irke
OF PERMITTEE
FINAL
VAUDATIO ROBERT A.WOOD
CK. M.o. `cnsH SUPERVISING MECHANICAL ENG'R
- L01-84o MAR 3 5D 15.0 0-- q