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76A567 .CERBIT 9APPLICATION FOR PLUMBINd PERMI
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING ��((
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS x5724 Iy
1. Oak _
WILLIAM A. JENSEN. SUPT OF BUILDING LOCALITY JeIrgoteatL
FOR APPLICANT TO FII.'. IN I NEAREST/ ��� i711��
CROSS ST. gg.
NUMBER FIXTURE OR ITEM EACH FEE /I OWNER 100MG.i.Ca, Un,iCAL%
3P-/aU
WATER CLOSET $1.25 / J
/' / ADDRESS
MAIL
BATH 'fU1 1.25 J
SHOWER 1.25
CITY TEL. NO.
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LAVATORT 1.25 CONTRACTOR( UJWUWe (PtLoRbi •J
SINK , � !^ �1 1 1.25 ADDRESS 411p J,�.,Y�'�.�''•�'.7_ le[�,..� �R�_amn a Ud�IW.L,,.JJT7_
DISHWASHER 1.25 CITY i�20,tlA.11/A L Pa)& TEL. NO.11=L! -
-APPROVALS
LAUNDRY 1.25
CONTRACTOR'S
REGISTRATION NO.
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1 i 4 COUNTY ❑
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CLOTHES WASHER 1.25
WATER HEATER 1.50 -
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°PRRSPCESSED BY
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FINAL
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V%LIDATION ROBERT A. WOOD
C� M. o. CASH SUPERVISING MECHANICAL
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GAS SYSTEM OUTLETS 1.50
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_ INDUSTRIAL
WASTE APPROVAL
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OUTLETS OVER 5 PER SYSTEM .00
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INSPECTION RECORD
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-APPROVALS
INSPECTORS SIGNATURE
PERMIT S 2 1 UNDER SLAB WORK
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a TOUGH PLUMBING
TOTAL FEE II .� 1' I GA, PIPJ NG
/GRATE
I HEREBY ACKNOWLCDGE THAT 1 HAVE READ THIS APPLICATION _ GAS VENT
ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY _
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING - HOT WATER HEATER
PLUMBING./II
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
CE
LINSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF -GAS TEST
CALIFORNIA OR THAT I A HE LEG OWNER OF, AND INT TO
RESIDE IN, THE AEOV/ iy IB(E,D/�R ISO TSA PE Y.-�.UTILITY CO; NOTIFIED
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PERRE TES-/'� A/
FINAL
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L�yJ M•�l .I
V%LIDATION ROBERT A. WOOD
C� M. o. CASH SUPERVISING MECHANICAL
ENG
ENG'R
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