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. APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
COLEMAN W. JENKINS. SUP'T..OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE
WATER CLOSET tk25 MAIL
I BATH TUB I, P•� ADDRESS
SHOWER Iva 7 CITY TEL NO.
LAVATORY CONTRACTOR
SINK 4A& S'� ADDRESS
DISHWASHER 1.25 " CITY TEL. NO. 41Y{3-00.. O
STAT LIC
LAUNDRY TUB 11.25 LICENSE NO. CLASS
CLOTHES WASHER ` O DISTRICT NO. I GROUP I ZONE P OG SED BY
WATER HEATER 1.50 ,j d S—, (J
GAS SYSTEM OUTLETS 1'52 INDUSASTE PP INDUSTRIAL
p
OUTLETS OVER 5 PER SYSTEM .30 v
INSPECTION RECORD �
O
W
a
h
Z
APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT S 2 00 UNDER SLAB WORK i I
ROUGH PLUMBING
TOTAL FEE GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT.AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER NEATER
PLUMBING.
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED .AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT 1 AM THE.LEGAL OWNER'OF,AND INTEND TO
'RESIDE IN.THE ABD IBED RESIDENTIAL PROPERTY. UTILITY-CO.NOTIFIED
SIGNATURE
OF PERMITTEE /
FINAL 4
LIDAT1014 JACK R:ALLEN
CK. M.0. CASH SUPERVISING MECHANICAL,ENG'R.
2 7 2 Sts JM22 5 D 19.7 5ev