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APPLICATION FOR PLUMBING PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISIONBUILDING "?VF
JOHN A. LAMBIE, County Engineer ADDRESS /
CASSATT D. GRIFFIN,Sup t of Building LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM
OWNERi..
WATER CLOSET ��
BATH TUB A DRESS d4�
SHOWER CITY TEL. NO.
LAVATORY CONTRACTOR
SINS ADDRESS .
DISHWASHER CITY TEL. NO.
CON ION � STATI LAUNDRY TUB REGISTRATION NO. 4 J COUNT
CLOTHES WASHER DIST O. GROUP
P ZONE ESS BY
WATER HEATER I
v
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
n
APPROVALS
OR FIXTURE $ / d�
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT $ 2 00 ROUGH PLUMBING
TOTAL FEE _ 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
I 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 THE LEGAL OWNER OF THE ABOVE UTILITY CO.NOTIFIED
DESCRIBED RESIDENTIA 0 ERTY.
SIGNATURE
OF PERMIT" FINAL19 ic
ROBERT A.WOOD.
OF VALIDATION SUPERVISING MECHANICAL ENG'R
M.0. CASH
L6E0 3 7 9 3 °; [ AR 2(D 5 A 3.0to