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APPLICATION FOR PLUMBI G PERM
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
NUMBER FI)gURE OR ITEM EACH FEE CROSS
OWNS
WATER CLOSET $1.25 ANDD
BATH TUB 1.25 -
SHOWER 1.25 -Cl TEL. N6. 117,01.1ael)
LAVATORY 1.25 en
CO CTO
SINE 1.25 JIDDRE88 Q
DISHWASHER 1.25 CI TEL. NO
LAUNDRY TUB 1.25 SATE LIC
LICEO
NSE . CLASS
CLOTHES WASHER 1.25 DISTRICT NO. Z E P S BY
Ao WATER HEATER 1.50
GAS SYSTEM OUTLETS 1.50 INDUSTRIAL O
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .90 INSPECTION RECORD U
O
F-
U
W
t/1
Z
APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER•SLAB WORK
ROUGH PLUMBING
TOTAL FEE GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCE8 AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED NGELES COUNTY AND STATE OF AS TEST
CALIFORNIA OR TH AM THE.L AL OWNER OF,AND INTEND
RESIDE IN.THE A VE DESCRIBE TIAL PROPERTY. •Ti LITY CO.NOTIFIED
SIGNATURE /
OF PERM ITT
FINAL - -/ �'4��
VALIDATION
CK.
M.0. CASH
i}'i a 8 614.0°ko- MAY 19 5 a 3.5.4