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APPLICATION FOR PLUMBI4G PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION 77
UILDING �
JOHN A. LAMBIE, County Engineer ADDRESS ,
CASSATT D. GRIFFIN, Sup't of Building LOCALITY
C
FOR APPLICANT TO FILL IN NEAREST
cltoss ST.
NUMBER FIXTURE OR ITEM
OWNER LL
WATER CLOSET MAIL
1 BATH TUB ADDRESS
CITY NO.
SHOWER
LAVATORY CONTRACTOR L
SINS ADDRESS
DISHWASHER
CITY NO. 3
CONTRACTOR'S STATE
LAUNDRY TUB REGISTRATION NO. COUNTY ❑
CLOTHES WASHER DISTRICT NO. GROUP ZONE PR CESSED BY
/ WATER HEATER
l
/ GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
/Ze
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l
L.4-1L LA
0 $1.00 PER ITEM
OR FIXTURE �b d �� APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
T / b ROUGH PLUMBING
TOTAL FEE
GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. HOT WATER HEATER
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO. NOTIFIED
SIGNATURE
ATURETTE �� ��Q-
PERM . »//
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FINAL /
®r ,�AJIDATION ROBERT A. WOOD,
Y.0. CASH SUPERVISING MECHANICAL ENG'R
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