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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILD'NG
JOHN A LAMBIE COUNTY ENGINEER ADDessS — G C L
COLEMAN W JENKINS SUP T OF BUILDINGALrry
C
FOSE APPLICANT TO FEL IN RT
NUMBER FIXTURE OR ITEM EACH FE[ OWNI
WATER CLOSET $1 75 MAIL /
AII
HATH TDD 175 � ADDHFJIH
SHOWER 175 CRY TEL NO
LAVATORY175 CONTRACTOR V VV
Snm 125 ADDS / CH r1 i v 1
DBHWAHHn 175 CITT l`/ N AO v/p TEL NO 3_VATE LIC
LAUNDRY TDB 175 LICENSE NO ��� / CLASS
CLOTHES WASIM 115 DISTRICT O 6 E PROCESSED BY
WATER HEATER 150 e
GAS SYSTEM OUTLETS 150 _ INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM 70 c�
RSSPErnoa eEcoeD
0
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APPROVALS DATE INSPECTOR 5 SIGNATURE
PERMIT S y OO UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE
GAS PIPING
1 XERSEYSTATE ACENOWL[OGE THAT I HAVE AND THIS ATLCOMPLN GAS VENT
AND STATE THAT TH[ ApOV[ lE CC
AND AOR[[ TO COMELY
WITN ALL COUNTY ORDINANCES AND RAT[ LAW[ REGULATING HOT WATER HEATER
PLUMBING
I HERIDr CERTIFY THAT 1 AM PROPERLY REGISTERED ANDIOR PLUMBING FIXTURES
LICENSED AE REQUIRED BY LO[ ANGELES COUNTY AND STAT[ OF GAS TEST
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF AND INTEND TO
RES10[ IN THE ASOVE DESCRIBED R4ID[ZQ;�
UTILITY CO NOTIFIED
SIGNATURE
OF PERMITTEE
FINAL
CRVALIDATION J EN
R. ALLM G CASH SUPERVISING MECHANICAL ENG'R
LAC04 9 4 9 SEP, 2 6 5 D 3.5 0"