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APPLICATION F R PLUMBI G PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
WILLIAM A.JENSEN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST f
CROSS 3T. .
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET $1.25 ' MAIL
BATH TUB 1.25 3 ADDRESS o f v L
SHOWER 1.25 CITY TEL. 90.
LAVATORY 1.25 s, CONTRACTOR
SINS 1.25 ADDRESS
DISHWASHER 1.25 CITY L. NO
LAUNDRY TUB 1.25 CONTRACTOR'S ATE [I
REGISTRATION NO. �S COUNTY ❑
CLOTHES WASHER 1.25 DISTRICT NO. GAUP -try
76-01-ov",
ROCESSED BY
WATER HEATER 1.50 +D & L pp
GAS SYSTEM OUTLETS 1.50 INDUSTRIALWASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .30 nIIV PECTION RECORD L)
el 0
IL
to
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APPROVALS A� E INSPECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE 11 GAS PIPING ! I
I HEREBY ACKNOWLEDGE THAT I HAVE READ HIS A PLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND GREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER �r
PLUMBING.
I HEREBY CERTIFY THAT I 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'I'EST
RESIDE IN,THE ABOVE DESCRIBED RES ENTIAL PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE �J
OF PERMITTEE FINAL '!I f � I1f �vG�
DATION ROBERT A.WOOD
CK. M.0. CASH SUPERVISING MECHANICAL ENG'R
L460 6 oI r%'rJ I:JL J.. 5 D