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APPLICATION FOR PLUMBI G PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER 7AZDDR:9 ;,3
Bff. CL IND SAFETY DIVLSION JOHN A BIE COUNTY ENGINEERWILLIAMA JENSEN Sup T OF BuILo1NG FOR APPLICANT TO FILL IN (Dt' ZvS.4 .COIANZ�NUMBER FIXTUR!OR ITEM EACH FEWATER CLOSET 5125
MATH IIID 125
SHOWER 125 cm EAeP4E- Cir TEL NO
LAVATORY 125 commcron p,Q,,igy i ,66- co
SINK 125 ADDRESS Ce) C, LO
DISHWASHER 125 crlT �iE� TEL NO#r4eV6'
LAUNDRY TUB 115 CONTRACTOR S STATE
REGISTRATION No 67/ COUNTY
CLOTHES WASHER _ 125 OISTW�Npl 6gOUP 6 P CIGBED BY
WATER HEATER ISO
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GAS SYSTEM OUTLETS 1!0 RIDUSTRUIL
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM 90
INSPECTION RECORDAAlV
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APPROVALS DATE INSPECTOR 5 SIGHATURE
PERMIT E Z 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE
GAS PIPING
I HEBERY ACKNOWLEDGE THAT I HAVE R[AO THIS APPLICATION GAS VENT
ANO STAT[ THAT THE ABOVE I[ CORRECT AND AOKE[ TO COMPLY
WITH ALL COUNTY OBD INANCES AND STATE LAWS REGULATING
PLUMBING HOT WATER HEATER
I HeNpv CERTIFY THAT I AM FROPERLY REGISTERED AND/on PLUMBING FIXTURES
LICENSED AS R[OUIR[D BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFWNIA OR T I AM THE LEGA WN
OF AND INTEND TO
RESIDE IN THE A [ O[KRIS R ESP.
UTILITY CO NOTIFIED
SIGNATURE
OF PERMITTE
FINAL
/ VALIDATION ROBERT A WOOD '
(\ cK J Al o CASH SUPERVISING MECHANICAL ENG R
LG.o_Wy)4;3 As 12 5 D' — 350-