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76AG67-CE0817 10-62 `
APPLICATION FOR PLUMBIN PERMIT ' � .
COUNTY OF LOS ANGELES "U' V
DEPARTMENT OF COUNTY ENGINEER 1�f
BUILDING AND SAFETY DIVISION BUILDING
JOHN A.LAMBIE. COUNTY ENGINEER ADDRESS
WILLIAM A.JENSEN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
fu WATER CLOSET $1.25 MAIL
BATH TUB 1.25 ADDRESS Oo Sr-
SHOWER 1.25 CITY TEL. NO.Gf _D31
LAVATORY 1.25 CONTRACTOR '
SINS 1.25 ADDRESS
DISHWASHER 1.25 CITY W ' TEL. NO.,C-jD3.0 D.d
LAUNDRY TUB 1.25 CONTRACTOR'S o ��� STATE
REGISTRATION NO. COUNTY ❑
CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE CESSED BY
WATER HEATER 1.50 `1 `�
GAS SYSTEM�OUTLETS 1.50 INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD u
8C
III
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'�' APP_ O�fA'L'•SI,,,. DATEa INSPEC_TOR'S SIGN TORE
PERMIT 5 2 00 UNDER - -B WORK C/v` � rte""—' ,r-.yy Y�nyr!t•1
ROUGH PLUMBING J
TOTAL FEE GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT + JJ
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ,,,rf>l"•
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
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 THATI AM T LEGAL OWNER OF,AND INTEND TO GAS TEST
RESIDE IN,THE ABOVE D.S D RESIDEN L PROP Y. UTILITY CO.NOTIFIED ') -rjU :, ', '�: ��"-• / '��
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SOF ATUREPERMI7EE
FINAL fa.�7l�) %%:!! s '!li•✓
LIDATION ROBERT A.WOOD
CK. M.O. CASH SUPERVISING MECHANICAL ENG'R
�t,l;o 5 4 3 4 `AY 31 5 0 1 5-C,0