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APPLICATION FOR PLUMBING PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A LAMBIE County Eag�neer
C TT D GRIFFIN Supt of Building I OCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM
WATER CLOSET OWNER
MAIL
BATH TUB ADDRESS r�
CITY TEL NO
SHOWER
LAVATORY CON72 OR
SINS ADDRESS
DISHWASHER CITY TEL NO
CO RAC S STATE
LAUNDRY TUB REGISTRATION NO COUNTY ❑
CLOTHES WASHER DISTRICT NOGR UP NE PROCESSED BY
WATER HEATER
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
APPROVALS
@ $I 00 PER ITEM I
OR FIXTURE $ DATE INSPECTOR S SIGNATURE
UNDER SLAB WORK
PERMIT $ 2100 ROUGH PLUMBING
TOTAL FEE GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING PLUMBING FIXTURES D4 5V
I HEREBY CERTIFY THAT AM P OPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY OS GELES COUNTY AND STATE OF
CALIFORNIA OR THAT I T LEGAL 0 ER OF THE ABOVE UTILITY CO NOTIFIED
DESCRIBED RESIDENTIA RORTY
SIGNATURE FINAL
OF PERM 1 TTE
ROBERT A WOOD
OF VALIDATION, UPERVISING MECHANICAL ENG R
CK d O CASH
LACO 4 7 6 4 i; AN 9 5 A 3 00