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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FN5AF
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A.JENSEN, SUPT OF BUILDING
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FOR APPLICANT TO FILL IN . _oIr
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NUMBER - FIXTURE OR ITEM EACH FEE-
OWNER
WATER CLOSET $1.25
MAIL
BATH TUB L25 ADDRESS
SHOWER 1.25 CITY TEL. NO.
LAVATORY1.25 F.� CONTRACTOR
SINS 1.25 S ADDRESS .
DISHWASHER 1.25 CITY TEL. NO
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LAUNDRY TUB 1,25 CONTRACTOR'S STATE
REGISTRATION NO. COUNTY .
CLOTHES WASHER 1.25 DI CT NO. GROUP ZONE P ChgESSED BY
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WATER HEATER 1.50
GAS SYSTEM OUTLETS 1.50 INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER S PER SYSTEM .90If INSPECTION RECORD
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Z31— APPROVALS DATE INSPECTOR'S 51,PNATURE
PERMIT $ 2 00 UNDER SLAB WORK
ROUGH PLUMBING r '_ 7 '�
TOTAL FEE GAS PIPING /��`�'F e "
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT �
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY JP_J�S1A
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COUNTY ORDINANCES AND STATE LAWS REGULATINGHOT WATER HEATER `F 4' f f. I .., ,J„C.{�.Y.CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURESAS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
A OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO GAS TEST THE ABOVE DESCRIBED RESIDENTIALPROPERTY. UTILITY CO.NOTIFIED
RE fMITTEE 001; FINAL
eALIDATION ROBERT A. WOOD
M.O. CASH SUPERVISING MECHANICAL ENG'R
LACG 5 1 8 4" OCT 4 5 D 15.00, 1-