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APPLICATION FOR PLUMBING PERMIT .
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY :DIVISION FNEAREST
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JOHN A. LAMBIE, COUNTY ENGINEER o� 3
WILLIAM A.JENSEN,SUPT OF BUILDING `
FOR APPLICANT'TO FILL IN Lr.
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET $1.25 MAIL
BATH TUB 1.25 Zj ADDRESS
SHOWER 1.25 CITY TEL. NO.
LAVATORY 1;25 �� CONTRACTOR i
SINK 1.25L-S 04441
ADDRESS '� t
DISHWASHER 1..25 CITYIr TEL.NO.'. 2
LAUNDRY'PUB 1.25 CONTRACTOR'S STATE
REGISTRATION NO. COUNTY
CLOTHES WASHER 1.25 1 `LS DISTRICT NO. GROUP %ONE PROCCESSED BY
WATER HEATER 1.50 16-0 •S.D1 ,L Q C�c9 LOVI2-
1.50 INDUSTRIAL
GAS$YSTEM_ OUTLETS l WASTE APPROVAL o.
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD, s , u
APPROVALS DATEIf INSPECTOR'SJSIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK f 11 1 / ../,(�pp�;'
ROUGH PLUMBING b/1V _ ' ', /Z,�:�
TOTAL FEE d� GAS PIPING
1 HEREBY ACKNOWLEDGE THAT i 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 HEATER
PLUMBING.
LRESIDE.IN
HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
CENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
LIFORNIA OR TIIAT 1 AM THE LEGAL OWNER OF,AND INTEND TO •GAS TEST
,THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED
GNATUREF PERMITTEE / "V \
FINAL
VALIDATION ROBERT A.WOOD
CK. M.O. CASH SUPERVISING MECHANICAL ENG'R
LR�o 4 5 7 4'\O' "AY 13 .5 D. - 15.0 0 y