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APPLICATION FOR PLUMBING PERMIT �
COUNTY OF LOS ANGELES
DEPARTMENT OLI NTY ENGINEER
BUILDING TY RIVISION BUILDINGJOHN A L MN�TY NGINEER ADDRESS
WILLIAM A JEBUILDING
LOCALITY
FOR APPLICANT TL IN NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM 74OWNER
WATER CLOSET MAIL
ADDRESS
BATH TUB
SHOWER CITY TEL NO S-
LAVATORY CONTRACTOR
SINS ADDRESS
DISHWASHER CITY TEL NO
CONTRACTOR S STATE ❑
LAUNDRY TUB REGISTRATION NO COUNTY ❑
CLOTHES WASHER DIS RII�CT N I GR I NE PROCESS__ //BY
WATER HEATER d (�
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD y
a
u
C�At e l2�, !. _ o
' iT Gt J,fa�-s
V 00 PER ITEM I v
OR FIXTURE $ APPROVALS DATE INSPECTOR S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
TOTAL FEE ROUGH PLUMBING
GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT Bl
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY $
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING HOT WATER HEATER Ac P � ^
_
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 I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED s"7 y�/yam e R p v4R.�
SIGNATURE I �w4Y r rl Pf�A►
OF PERM ITTU&aFINAL
Of VALIDATIO ROBERT A WOOD
Cs m 0 CASH ERVISING MECHANICAL ENG R
Lf36 J D 400 M