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APPLICATION FOR PLUMBI G PER
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS W-flf,/
COLEMAN W. JENKINS. SUP'T.. OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIYTURE OR ITEM EACH FEE OWNER S •
WATER CLOSET $1.25 EL /
BATH TUB 1.25 DD
SHOWER 1.25 CI TEL. a .
LAVATORY 1,25 CONTRACTOR
SINS 1,25 ADDRESS
DISHWASHER 1.25. C=
STATE LIC
LAUNDRY TUB 1.25 LICENSEal. CLASS
CLOTHES WASHER 1.25 DI ICT ZON P Y
WATER HEATER 1.50
ic
GAS SYSTEM OUTLETS 1.50 INDUSTRIAL O
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .90 INSPECTION RECORD U
- 1-
V
w
o.
tq
Z
APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT 5 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IB CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
'PLUMBING.
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF 'GAS TEST
CALIFORNIA OR THAT 1 AM HE LEGAL OWNER OF,AND INTEND TO
RESIDE IN,THE ABOVE DE BE ESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE
OF PERMITTEE- FINAL
/.l
VAL
CK. M.0.
M.0.
CASH
28.5' 9 JM30 5 0 3.50- 0