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• ARPLICATION FOR PLUMBI G PERMIT
COUNTY OF LbS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
COLEMAN W. J•ENKINS. SUPT. OF BUILDING'
LOCALITY I
FOR APPLICANT TO FML.IN NEAREST
CROSS ST. pi- L
NUMBER FIYTURE OR ITEM EACH FEE
OWNER S -7'o
WATER CLOSET 51.25
BATH TUB 1.25 MAIL ESS
` SHOWER 1.25 CIlY �v / f TEL. NO. j'J�b0
LAVATORY 3,25 CONTRACTOR
SINS 1.25 ADDRESS
DISHWASHER 1.25 CITY TEL.NO.
LAUNDRY TUB' 1,25 STATE LIC
LICENSE NO. CLASS
CLOTHES WASHER 1.25 DISTRICT NO. GR E P BY
WATER HEATER 1.50
GAS SYSTEM OUTLETS
1.50 WASTE AP ROVAL CD
OUTLETS OVER 5 PER SYSTEM .90 INSPECTION RECORD c�
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APPROVALS DATE INSPECTTURK
PERMIT S 2 Oo UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE GAS PIPING V
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLIC ION GAS VENT
AND STATE,THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE
LA REGULATING ,HOT WATER HEATER •�`�• �'e
PLUMBING.
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED :AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO GAS TEST
RESIDE IN,.THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CM NOTIFIED
SIGNATURE
OF PERMITTE + - k
FINAL
LIDATION JACK R.ALLEN
CK. M.0. CASH SUPERVISING MECHANICAL ENG'R.
LHCQ-O 3 4,9% RUG29 5 D 8.75-