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APPLICATION FOR PLUMBING PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION � SQ ��
JOHN A LAM �n
BIE CountF Engeer
CASSATT D GRIFFIN Supt o4 Building LOCALITY
FOR APPLICANT TO FILL IN NEAREST
NUMBER FIXTURE OR ITEM CROSS ST
OWNER
WATER CLOSET MAIL
BATH TUB ADDRESS
SHOWER CITY TEL NO
LAVATORY CONTRACTOR
SINK ADDRESS /3 j�
DISHWASHER CITY TEL NO U 1 3
LAUNDRY TUB CONTRACT08 S y If-o& _ o2.,PC STATE
REGISTRATION NO } �d COUNTY
CLOTHES WASHER DISTRICT NO GROUP ZONtAQCESSED BY
I
WATER HEATERdyja
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
APPROVALS
PER r=
OR DITURE s Vv
DATE INSPECTOR S SIGNATURE
UNDER SLAB WORK
PERMIT $ 2 00 ROUGH PLUMBING '
TOTAL FEE GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
r �
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING �f
PLUMBING PLUMBING FIXTURES
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST -2</r �i
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO NOTIFIED /0- r—
DESCRIBED RESIDENTIAL PROPE15Y
SIGNATURE
OFPERM TTE V'� y FINAL .0- V/ �
ROBERT A WOOD
OF ALIDATION SUPERVISING MECHANICAL ENG R
CK N 0 CASH