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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
B oIH.ljAAMig ESt ENT7,TMt ENIVLNEON BUILDING
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f WILLIAM A JENSEN, SUPT OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN CROSS
NUMBER FIXTURE OR ITEM OWNER
j WATER CLOSET
+ BATH TUB ADDRESS
CITY TEL NO.
SHOWER
LAVATORY
CONTRACTOR
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SUM ADDRESS
DISHWASHER CITY D44woaz& TEL NO--,r4 I&-
CONTRACTOR'S STATE
LAUNDRY TUB REGISTRATION NO. 6 COUNTY
CLOTHES WASHER DISTRICT NO GROUP ZONE PRQcESSED BY
J WATER HEATER
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD o_
4 ra! o
Lu
B $100 PER ITEM '
OR FDCTURE S APPROVALS DATE ,INSPECTOR S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
TOTAL FEE ROUGH PLUMBING
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1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ TXIB LIGATION GAS PIPING
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL,COUNTY ORDINANCES AND STATE LAWS REGULATING A
PLUMBING HOT WATER HEARERy �r�Hf
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTUR ®�I fi yA JI .G' .G1
b y��
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST �/ v y��(v
CALIFORNIA OR THAT I AM THE EGAL OWNER OF THE ABOVE �`
DESCRIBED RESIDENTIAL P E UTILITY CO NO IFIED 2l
SIGNATURE �� �I� / %��
OF PERMITTE FINAL ,
LIDATION ROBERT A WOOD
M 0 CASH SUPERVISING MECHANICAL ENG R '