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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS
CASSATT D. GRIFFIN, Sup't of Building
LOCALITY
` FOR APPLICANT TO FILL IN 4 NEARESSCROSS T.
NUMBER FIXTURE OR ITEM
OWNER
WATER CLOSET MAIL
ADDRESS
BATH TUB
CITY TEL. NO.
SHOWER
LAVATORY CONTRACTOR
SINS ADDRESS 840 SO. 41I'!U@
DISHWASHER
CITY Arcaclila, CTEL. NO.
CONTRACTOR'S STATE ]
LAUNDRY TUB REGISTRATION NO. r, COUNTY
CLOTHES WASHER DISTRIC_T.?!O. GROUP ZONE O ESSE17 BY
WATER HEATER *✓ I � "` -LL
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
a @ $1.00 PER ITEM
--� OR FIXTURE $ APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
TOTAL FEE I ROUGH PLUMBING
GAS PIPING
I 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
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO. NOTIFIED
SIGNATURE .x
OF PERMITTEE
FINAL
®FVALIDATION ROBERT A. WOOD,
OI;. M.0. CASH SUPERVISING MECHANICAL,ENG'R