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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A LAMBIE CountF Engineer ADDRESS -6'0A n
CASSATT D GRIFFIN Sup t of Building
LOCALITY l.C� frLd
FOR APPLICANT TO FILL IN N T
T L
NUMBER FIXTURE OR ITEM
WATER CLOSET OWNS 9
BATH TUB
bum
RESS
CITY 71-411LL GL TEL NO
SHOWER
LAVATORY CONTRACTOR 1-14
SINK ADDRESS 41/qe ,5 SGfi(v !,-6s e l
DISHWASHER CITY4/L(rILLr /TEL NO
CONTRACTOR SATE
LAUNDRY TUB REGISTRATION NO r/�G s' COUNTY ❑
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CLOTHES WASHER DISTRICT NO GROUP ZO E P SSED BY
WATER HEATER
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
APPROVALS
@ OR$1PFDCfUBT g / 00
DATE INSPECTOR S SIGNATURE
UNDER SLAB WORK
PERMIT S 2 00 ROUGH PLUMBING
TOTAL FEE 3 00 GAS PIPING
I HEREBY ACKNOWLEDGE THAT I 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
1 HEREBY CERTIFY THAT I AM 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 RESIDENT L PROPERTY.
SIGNATURE / C(��
OFPERMITTE ZL O t-ui FINAL / `f L _ O
OF vVALIDATION ROBERT A WOOD y
SUPERVISING MECHANICAL ENG R
CK !1 0 CASH
L 0 '- In OCT 5 5 A 300 t