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76A667-CE817-11-57
APPLICATION FOR PLUMBING PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS
CASSATT D. GRIFFIN. Supt of Building LOCALITY.--` D� �L s� /yV RO
FUM
OR APPLICANT TO FILL IN NEAREST
CROSS ST.
FIXTURE OR ITEM
OWNER
WATER CLOSET
MAIL
BATH TUB ADDRESS
SHOWER CITY /G/'/ /-'LL C;/SEL. NO.
LAVATORY CONTRACTOR �G L f•,e V� �/
SINK ADDRESS / O3'6 � 6,90 i L[.v S%p
DISHWASHER CITY �� 1114'-3 TEL. NO.
CONTRACTOR'S STATE
LAUNDRY TUB
REGISTRATION NO. �6 f> C Z G COUNTY ❑
CLOTHES WASHER DIST
hJ CT NO. I GROUP I ZONE READY FOR INSPECTION
WATER HEATER �/ A'
r GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
i
l
APPROVALS
dal $1.00 PER ITEM DATE INSPECTOR'S SIGNATURE
OR FDITURE $ `f
UNDER SLAB WORK
PERMIT 00 ROUGH PLUMBING
TOTALFEE -01 - 1 t,v 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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST -"
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE UTILITY CO. NOTIFIED
DESCRIBED RESIDENTIAL PROPERTY.
RE
OFPER �/ FINAL
OF PERM ITTE
ROBERT A.WOOD.
®F ,VALIDATION SUPERVISING MECHANICAL ENG'R
M.O. CASH