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�APPLICCAT�CN FO PLUMBI G PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER - FNEAREST
BUoIH.NI1AG AA�NB EcFo�E�1'�Y�
DM3EON �-WILLIAM A.JENSEN,SUPT OF BUILDING FOR APPLICANT TO FILL IN CROSS y
NUMBER FIXTURE OR ITEM EACH FEE
OWNER �®
WATER CLOSET %.226 ` MAIL
BATH TUB i ADDRESS
•CITY TEL. NO.
SHOWER 1.25
LAVATORY 1,25 CONTRACTOR
SINK 1.25 1 LIL<'
ADDRESS
DISHWASHER. 1.25 CITY Hawthorne Tn. NO.
LAUNDRY TUB 1.25 REGINSTRA=ION NO. 19361''7' C-36 COUNTY p
CLOTHES WASHER 1.25 ` DISTRICT No GROUP ,ZrO E C ESSED BY
WATER HEATER 1.50 U // L
I RI
GAS SYSTEM OUTLETS 1'M WASTE AAPPPPROVAL O
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD A V
. CL
/ O
In
>51L��A •r Z
1. V
r
APPROVALS qATF, INSPECTOR'S SIGN_ E
PERMIT S 2 00 UNDER SLAB WORK
ROUGH PLUMBING �v
TOTAL FEE �� GAS PIPING �d7r '{�e .v.vi�
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY d% �'/•I
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATERI J"
PLUMBING. ` AV �
1 HEREBY CERTIFY THAT i AM P ERLY REGISTERED AND/OR PLUMBING FIXTURES
.LICENSED A8 REQUIRED BY LOS .N LES COUNT AND 'TAT' OF
GAS TEST �" � 1
CALIFORNIA OR THAT I AM THE OWNER AND INTEND'TO _
RESIDE IN,THE ABOVE El ID ALP PERTY UTi LITY CO.NOTIFIED
SIGNATURE
OF PERMITTEE FINAL
ff AIMATION ROBERT A: WOOD v v
cK. M.O. CASH SUPERVISING MECHANICAL ENG'R
1 .'4. 8MAY1� .5 D 11.25M
. _ _