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. APPLICATION FOR 'PLUMING PERMIT
COUNTY OFI LOS ANGELES
DEPARTMENT OFrCOUNTY ENGINEER t EBUILDINGBUILDING AND $AFETY DIVISION DRESSJOHN A. LANI6fE. COUNTY ENGINEER I">Y C7 y�.olYiii b:ll 'QCASSATTD,. GRIFFIN, SUPT of BUILDING CALITY {y
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FOR APPLICANT^TO FILL, IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM
OWNER
WATER CLOSET
MAIL
BATH TUB ADDRESS s.
SHOWER, ! CITY . TEL.NO.
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5 ..:. CONTRACTOR �+r :
LAVATORY• Env M .
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SINK, ADDRESS 2 -tille, w * d� - _?
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DISHWASHER: CITY, __+ TEL.NO. g,7F it .
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LAUNDRYTUB CONTRACTOR'S""' 1STATE
1 REGISTRATION NO. �� �,��art. COUNTY ❑
CLOTHES WASHER
- DISTRICT NO. GROUP. ZONE READY FOR INSPECTION
WATER HEATER
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
771
APPROVALS
$1.00 PER ITEM ' DATE INSPECTOR'S SIGNATURE
en': "' ORFIXTURE $ UNDER SLAB
AD
- ROUGH PLUMBING -
PERMIT S 1 00 -
- GAS PIPING •'
TOTAL FEE -GAS VENT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER NEATER
�• AND STATE THAT TFIE...ABOVE AS CORRECT AND AGREE TO COMPLY
WITH .ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES
PLUMBING. i.
'•1_HEREBY CERTIFY' THAT I AM PROPERLY REGISTERED AND/OR GAS TEST s •;
LICENSED:AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CQ'LYf'F0 RNI A- OR THAT 1 AM T,HE LEGAL° OWNER OF THE ABOVE. UTILITY CO. NOTIFIED
. D.ESCRIBED RESIDENTIAL-PROPERTY
SIGNATUREG/
'OF
PERMIT
.. ,.•...,.-- , ':, _•.;..,. ..,,:__.. -.: ROBERT A. WOOD.
VALIDATION
i SUPERVISING MECHANICAL ENG R -
--%;" •• , (CK. M.O. CASH
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