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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 C
COLEMAN W JENKINS SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSSNEAREST
NUMBER FIXTURE OR ITEM EACH FRE
OWNER
WATER CLOSET 5195 NAM
BATH TOR 195 ADDRESS -
SHOWI95 CRT TEL NO
ER
LAVATORY ISS CONTRACTOR P
SDQ I Ts ADDRESS /d S /BLD
DISHWASHER III CITY T P. TEL NO
LAUNDRY TUB 125 SATE LIC
LICENSE NO 74 5CLASS ^
CLOTIM WASHER 195 DISTRICT N GROUP ZONE PR GHS D BY
WATER HEATER ISO ,S-^O
GAS SYSTEM OUTLETS "o WAIUSTMU
APPROVAL TE P
OUTLETS OVER S PER SYSTEM JD INSPECTION RECORD
q 7
/
APPROVALS DATE INSPECTOR[SIGNATURE
PERMIT S L2 OO UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE GAS PIPING
1 HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
AND STATETHAT THE ABOVE IE COMM" AND AGREE To c0HPLr
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING HOT WATER HEATER
I HEREBY CERTIFY THAT I AN PROPERLY REGISTERED AND/OM PLUMBING FIXTURES _
LICENSED AS REQUIRED BY LOB ANO[LLB COUNTY AND STAT[ or GAS TEST
CALIFORNIA OR THAT 1 AM TM[ ""L OWM
IIIR OF AND I [NO TO
mal DE IN TM[ABOVE DESCRIBED RESIDENTIAL PROPERTY
UTILITY CO NOTIFIED
YIGNATURQ
OF PERMITTER
FINAL �L{
ATION JACK R.rLEN
cK M o CAEH SUPERVISING MEC NICAL ENG'R
L& 8 6 O 3—� MAY17 5 D 4.75-
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