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APPLICATION FOR PLUMBING PER IT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS 7 _-
WILLIAM A.JENSEN, SUPT OF BUILDING
LOCALITY �� C•
FOR APPLICANT TO FILL IN NEARE T.
NUMBER FIXTURE OR ITEM EACH FEE OSS
OWNER .�
WATER CLOSET $1.25 MAIL
l BATH TUB 1.25 ADDRESS
/ SHOWER 1.25 CITY TEL. NO.
LAVATORY 1.25 CONTRACTOR
r t SINS 1.25 ADDRESS X 6
DISHWASHER 1.25 CI.TY TEL. NO.
LAUNDRY TUB 1,25 CONTRACTOR'S STATE [I
REGISTRATION NO. COUNTY ❑
CLOTHES WASHER 1.25
DIST!RjqT N GROUP ZONE P E SED BY
WATER HEATER 1.50
C>-
IL
GAS SYSTEM 4- 1.50 WAASTEAPAPPROVAL 0
OUTLETS OVER 5 PER SYSTEM .90
INSPECTION RECORD ,� ,-, :9
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i1 AA UO
1 1i A.v:1.. {/may �"�6;. C%•.
APPROVALS DATE IN ECT 'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK 42-
ROUGH
ROUGH PLUMBING
TOTAL FEE `j O O
GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY 1
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. ,HOT WATER HEATER A''t
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR .P PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF �q1
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO GAS TEST
RESIDE IN,THE ABOVE DESCRIB EBIDENTIAL PROPERTY. UTILITY CO.NOTIFIED r
SIGNATURE
OF PERMITTEE FINAL /
ALIDATION ROBERT A.WOOD
CK. M.O. CASH SUPERVISING MECHANICAL ENG'R
5 2 5 6 E FEB 4' 5 D 15,00- 11,