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APPLICATION _ FOR LUMBING VPERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION RUMDING �y
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS 9011 'r ljLlG�l%
COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEARESCROSS T.
d C
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET $Ln
MAM
BATH TUR 1.25 ADDRESS
SHOWER 1.25 CITY TEL. NO.
LAVATORY 1.25 CONTRACTOR
SINS 1.25 ADDRESS '� Zy O ..V
DISHWASHER 1.25 CITY TEL. NO. (l
STATE L-I C
LAUNDRY TUB 1.25 LICENSE NO. 3d ;L7 CLASS
CLOTHES WASHER 1.25DISTR�T NO. GROUP ZONE I PROCESSED BY
WATER HEATER 1.50 S . 09 r &elzAjje �
GAS SYSTEM OUTLETS 1.50 WAASTE P .p49
APPROVAL /- — (p.e� O
WAAPP
OUTLETS OVER 5 PER SYSTEM AD INSPECTION CORD U
MID -7- a
F-
U
W
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Z
APPROVALS DATE INSPECTORS SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE S Jam' GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT �r•1
AND STATE THAT THE ABOVE IB CORRECT AND AGREE TO COMPLYv�Y�4i�� ,..!.
WITH ALL 'COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER '
PLUMBING.
IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES 0
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST rryye f
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF AND INTEND TO
RESIDE IN,THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE i
OF PERMITTEE
FINAL !!
LMATION
CK. M.O: CASH
7 6.9 7 .- NRR 22 5 D 55 0- 9
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