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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES �-
DEPARTMENT A�OF COUNTY ENGINEER
BUILDING AF►-� S�gTY RIVISION BUILDING
JOHN A L IE OUNTY NGINEER ADDRESS
WILLIAM A JENSEN SUPT OF BUILDING _
LOCALITY
FOR APPLICANT TO FILL IN CROS SST L L G/YES
NUMBER FIXTURE OR ITEM
OWNER r' y
WATER CLOSET MAIL
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MAI
BATH TUB
ADDRESS 2 A ,
SHOWER CITY / NO ,Z Z
LAVATORY CONTRACTOR r
SINK ADDRESS
DISHWASHER CITY TEL NO
CONTRACTOR S STATE ❑
LAUNDRY TUB REGISTRATION NO COUNTY ❑
CLOTHES WASHER DISTRICT NO fGj!� ZONE PR SSEDBYWATER HEATER
GAS SYSTEM INDUSTRIAL
WASTE APPROYAL / f7
INSPECTION REC RD
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0
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@ ORF FIXTURE IT /
$ APPROVALS DATE INSPECTOR S SIGNATURE
PERMIT $ 7100 UNDER SLAB WORK
TOTAL FEE ISL/ ROUGH PLUMBING
GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING HOT WATER HEATER
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
CE
LINSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIA PROPERTY UTILITY CO NOTIFIED
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SIGNATURE
OF PERMITTE FINAL
®r VALIDATIoBERT A WOOD r ,
Cs m o UPERVISING MECHANICAL ENG R
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