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APPLICATION FOR PLUMBI G PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING `
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS A
WILLIAM A.JENSEN,SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST. '
NUMBER FIXTURE OR ITEM EACH FEE OWNER
WATER CLOSET $1.25 oorl,
MAIL
BATH TUB 1.25 ADDRESS
SHOWER 1.25 J CITY
LAVATORY 1.25 CONTRACTOR {�
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SINS 1.25 ADDRESS d
DISHWASHER 1.25 CITY TEL. NO./'
LAUNDRY TUB 1.25 CONTRACTOR'S / STATE
REGISTRATION NO. COUNTY ❑
CLOTHES WASHER 1.25 DISTRICT NO GROUP ZONE P OCEWD BY
WATER HEATER 1.50 0 J
GAS SYSTEM OUTLETS 1.50 Q INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .90
SPECTION REOORD
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APS k. . PATE/ INSPE TOR'S IGTIATURE
PERMIT $ 2 00 UNDE - WORK
ROUGH PLUMBING
TOTAL FEE GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. HOT WATER HEATER `i;I6
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANWOR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LANGELES COUNTY AND STATE OF �.
CALIFORNIA OR THAT 1 AM TO LEGAL OWNER OF,AND INTEND TO GAS TEST
RESIDE IN.THE ABOVE DESC RESIDENTI PROPE UTILITY CO.NOTIFIED
SIGNATURE �•a ' - a
OF PERMITTEE FINAL
VALIDATION
ROBERT A.WOOD
M.0. CASH SUPERVISING MECHANICAL ENG'R
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