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APPLICATION FOR PLUMBING PERMIT 1
COUNTY OF LOS ANGELES a
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS
CASSATT D. GRIFFIN,Sup't of Building LOCALITY T LE CITiC3
COUNTY
FOR APPLICANT TO FILL IN NEAREST T.
NUMBER FIXTURE OR ITEM
OWNER E
WATER CLOSET MAIL 'L4H
BATH TUB ADDRESS GN
SHOWER CITY TEMPLE CITY
LAVATORY CONTRACTOR ROBBINSPLUMBING
SINS ADDRESS 8725 NORBLVD.
DISHWASHER CITY LOS NIETON OX. 21286
CONTRACTOR'S STATE
LAUNDRY TUB REGISTRATION NO. 56272 COUNTY ❑
CLOTHES WASHER DISTRICT NO. GROUP ZONE PgESSED BY
WATER HEATER
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
a
APPROVALS
ER ITEM
OR F.00 IXTURE $
DATE. INSPECTOR'S SIGNATURE
7 UNDER SLAB WORK J
PERMIT $ 2 00 ROUGH PLUMBING
TOTAL FEE 0 GAS PIPING q
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 1 AM PROPERLY REGISTERED AND/OR GAS TEST '� 3'A! f �-Y-"----��
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF a
CALIFORNIA OR THAT I AM THE LEGAL OWNER_0 THE ABOVE UTILITY CO.NOTIFIED c "
DESCRIBED RESIDENTIAL PRQREkTY. /
SIGNATURE
OFPERMITTE d�r>ti.y
®p VALIDATION ROBERT A.WOOD.
SUPERVISING MECHANICAL ENG'R
CK. M.0. CASH
^i 6 r 5 !, c j
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