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APPLICATION FOR - PLUMBING PERMIT '
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
'BUILDING AND SAFETY DIVISION BUILDING `` a
JOHN A. LAMBIE, County Engineer ADDRESS (O -
CASSATT D. GRIFFIN,Supt of Building _ LOCALITY
FOR APPLICANT TO FILL-IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM
OWNER'
WATER CLOSET MAIL
BATH TUB ADDRESS
SHOWER CITY TEL. NO. �'
LAVATORY CONTRACTOR % �p
+ SINS ADDRESS ���!{ _
DISHWASHER CITY TEL. NO. 7
LAUNDRY TUB CONTRACTOR'S STATE K
REGISTRATION NO. COUNTY
c w�
CLOTHES WASHER DISTRICT NO GROUP ZONE 11ROCESSED BYy
WATER HEATER .-� .
q GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
r INSPECTION RECORD
APPROVALS
@ $1.00 PER ITEM / Q DATE INSPECTOR'S SIGNATURE.
OR FIXTURE
UNDER SLAB WORK
PERMIT $ 2 OO ROUGH PLUMBING
TOTAL FEE GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION ; GAS VENT
AND.STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. PLUMBING FIXTURES
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR r. GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF .:
CALIFORNIA OR THAT 1 A�M IHE LEGA WNER OF THE ABOVE UTILITY CO.NOTIFIED
DESCRIBED RESIDENTIAL RVYERTY. d'ZG4�
SIGNATURE n ^
or
OF PERM[ TE FINAL i
®F VALIDATION ROBERT PINMOOD ECHANICAL ENG'R
M.O. CASH`
,.'1-7 �j 7.-1" rte. I�`tj: -� ,.� ..