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APPLICATION OIC PLU ING P RMI °. �
COUNTY OF LOS ANGELES az
DEPARTMENT OF COUNTY ENGINEER
BUILDING ANDSAFETY �IVISION BUILDING
JOHN A. LAMBIE. COUNTY NGINEER ADDRESS
WILLIAM A. JENSEN, SUPT OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
caoss ST.
NUMBER FIXTURE OR ITEM OWNER
WATER CLOSET MAIL
BATH TUB ADDRESS �1
CITY .NO. . Tf
SHOWER
CONTRACTOR
LAVATORY
SINK ADDRES
DISHWASHER CITY r TEL. NO. 37
CONTRACTOR'S 77�� STATE
LAUNDRY TUB REGISTRATION NO. COUNTY ❑
CLOTHES WASHERDISTRIC.1 NO. GROUP ZONE S B
WATER HEATER
GAS SYSTEM INDUSTRIAL
s
WASTE APPROVAL
INSPECTION RECORD
a
O
U
m
0
F
U
W
P.
Enz
PER ITEM I /
/ ORF KTURE S APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
TOTAL FEE ROUGH PLUMBING
g/ -./
GAS PIPING f-..,�6,.;:,�',.`-;
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT V
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
LD�ESCRIBED
CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
S REQUIRED BY LOS ANGELES COUNTY AND STATE OFGAS TEST
OR THAT 1 AM THE LEGAL OWNER OF 7HE ABOYE RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIEDEITTEE 4Vz z FINAL
®P VA O�RoeERT A. WOOD,
M.0. (
\' cK. M.O. 'cesH /SUPERVISING MECHANICAL ENG'R
D
LrtC�J 4 4 1 0 r,�c 3 5 U 3 .0 0 '