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APPLICATION FOR PLUNKING PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS -3 2- 14-a$,5714,L./y ie c,
CASSATT D. GRIFFIN,Supt of Building LOCALITY fyj LF
FOR APPLICANT TO FILL IN NEAREST
CROSS ST. L! ev C
NUMBER FIXTURE OR ITEM
OWNER
WATER CLOSET MAIL
BATH TUB ADDRESS c-
SHOWER CITY ti TEL. NO.
LAVATORY CONTRACTOR G O
SINK ADDRESS -5-6a-i
DISHWASHER CITY C- TEL. NO.
CONTRACTOR'S / / STATE
LAUNDRY TUB REGISTRATION NO. / / COUNTY ❑
CLOTHES WASHER DIST GROUP GROUP ZONE P BY
WATER HEATER
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
C INSPECTION RECORD
i APPROVALS
@ OR FIXTURE $ t `-v
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT $ ?100 ROUGH PLUMBING
TOTAL FEE '3 0-i GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1HAVE 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
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNT AND STATE OF
CALIFORNIA OR THAT I AM TH LEGAL F THE ABOVE UTILITY CO.NOTIFIED
DESCRIBED RESIDENTIAL PRO
SIGNATURE
OF PERMITTEE FINAL —
ROBERT A.WOOD.
®F VALIDATION SUPERVISING MECHANICAL ENG'R
M.O. CASH
SCO5829 unAPR 28 5 A 3.00 � .