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76AG67.CE0817 10.82
APPL..ICATIO FOR PLUMBING PERMIT .
COUNTY OF LOS ANGELES b
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION 7NEAREST
JOHN A. LAMBIE, COUNTY ENGINEER z -
WILLIAM A.JENSEN,SUP'T OF BUILDING
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FOR APPLICANT TO-FILL IN oe
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NUMBER FIXTURE OR.ITEM EACH FEE
- - OWNER
WATER CLOSET $1.25 MAIL
BATH TUB 1.25 ADDRESS
SHOWER 1.25 CITY TEL. NO.
LAVATORY 1.25 CONTRACTOR Gces
t SINS 1,25 ADDRESS
DISHWASHER 1.75 CITY TEL. NO: %TE
3 3
LAIINDAY TUB 1,25 CONTRACTOR'S
REGISTRATION NO. TY
CLOTHES WASHER 1.25 DI ICT G P. DN PDBY
WATER HEATER 1.50 - p (/
50 INDUSTRIAL It
GAS SYSTEM OUTLETS— 1. WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .30
,INSPECTION RECORD �
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APPROVALS IDATE INSPECTOfi'S S fd1JAf-URE
UNDER SLAB WORK 7/26j,41,2 ��v
PERMIT S 2 00
o D ROUGH PLUMBING
TOTAL FEE GAS PIPING X19
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS 'AP LICATION p•.p)
AND STATE THAT THE ABOVE, IS CORRECT AND AGREE TO COMPLY GAS VENT ;y pYfl
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING. r,•:'
1 HEREBY CERTIFY THAT 1 AMPROPERLY REGISTERED AND/OR PLUMBING FIXTURES - i r �Z-1 Jy
LICENSED AS REQUIRED BY .LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO
RESIDE IN,THE ABOVE D CRIBED RESIDENTIAL PRWERTY. UTILITY CO.NOTIFIED
SIGNATURE
OF PERMITTEEmorNIIIIIIII
FINAL ��lC'1' ��3, ) •��
ALIDATION ROBERT A.WOOD
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M.0. CASH SUPERVISING MECHANICAL ENG'R
r1•�o 3 0 6 2 .;DL ?6 5 D 1 5. 0 N