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APPLICATION FOR PLUMBING PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
1OHN A LAMBIE Count VS
er ADDRESS . Aa
CASSATT D GRIFFIN Supt of Building LOCALITY
FOR APPLICANT TO FILL IN NEAREST
—
NUMBER FIXTURE OR ITEM CROSS ST
OWNER Deavz = C
/ WATER CLOSET MAIL
BATH TUB ADDRESS .9 3 RAW d
SHOWER CITY TEL NO
LAVATORY CONTRACTOR
SINK ADDRESS
DISHWASHER _ CITY TEL NO
CONTRACTOR S STATE [ILAIINDAY TUB REGISTRATION NO COUNTY
CLOTHES WASHER DISTRICT N:j GROUP I Z NE SED BY
WATER HEATER
GAS SYSTEM INDUSTRIAL '
WASTE APPROVAL
INSPECTION RECORD
APPROVALS
@ 9,000% r R rrEea
$ ? �y DATE INSPECTOR S SIGNATURE
v UNDER SLAB WORK
PERMIT $ 2 00 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 T
I HEREBY CERTIFY THAT 1 AN PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO NOTIFIED
DESCRIBED RESIDENTIA PROPERT
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81GNAT MIE
OF PERM ITTFINAL '--1\it ��i.•r
ROBERT A WOOD
Or VALIDATION SUPERVISING MECHANICAL ENG R
CK H O CASH
Llo1 0 1 30" AX 11 5 A 5 00 '�