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76A607 CE817 10 60
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FAUD
DING
JOHN A LAMBIE COUNTY ENGINEER ESS
WILLIAM A JENSEN SUP T OF BUILDING
LITY
FOR APPLICANT TO FILL IN NEAREST ST
NUMBER FIXTURE OR ITEM ER
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WATER CLOSE!BA,STUB ESS TEL.NO
SHOWER
LAVATORY
TRACTOR o
SINKADDRESS
DISHWASBER CITY TEM NO 740 51V
LAUNDRY TUB REGffiSTRATTIIONSNO COUNA7�Y
CLOTHES WASHER DISTRICT NOGROUP ZONE PROIZESSED BY
WATER HEATER ]
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
i INSPECTION RECORD ,
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eH
/0 a $1 ao PER TEEM
OR FMrURE S Q 6 APPROVALS DATE INSPECTOR S,FSI"GNATURE
PERMIT $ 2100 UNDER SLAB WORK
TOTAL FEE d ROUGH PLUMBING f M; II
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS PIPING
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 1/
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GA3 TEST (�
CALIFORNIA OR THAT i AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED A
SIGNATURE
OF PERMITTE FINAL
/"'-VALIDATION ROBERT A WOOD
CK M o CASH SUPERVISING MECHANICAL ENG R i
2 L" 29 12 00
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