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APPLICATION FOR PLUMBING PERMIT �
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS -i JO ¢,
WILLIAM A JENSEN SUP T OF BUILDING
LOCALITY02ENKIRNEW L4
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FOR APPLICANT TO FELL IN NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM
OWNER
WATER CLOSET z 2- MAIL
BATH TUB ADDRESS
SHOWER
CITY TEL NO
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CONTRACTOR � , , pusrt t
LAVATORY y
SINS ADDRESS 3 r
DISHWASHER C G p �cv� TEL NO �����
LAUNDRY TUB REGISTRATION NO STATE ❑�/ COUNTY ❑
CLOTHES WASHER DISTRICT NO GROUP ZONE PROCESSED BY
WATER HEATER n I
GAS SYSTEM INDIISTRIAL - 1
WASTE APPROVAL >_
INSPECTION RECORD D"
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N
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1
Iia $1 DOPER ITEM
OR FIXTURE $ APPROVALS DATE INSPECTOR SSIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
TOTAL FEE 3 J 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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGE S COUNTY AND STATE OF
j CALIFORNIA OR THAT 1 AM THE G L OWNER OF THE ABOVE GAS TEST ++
1 DESCRIBED RESID NTIAL PR ERTY UTILITY CO NOTIFIED 1 r f
SIGNATURE
J, +
OF PERMITTEEFINAL
F
VALIDATION ROBERT A tWOOD
cK M o CASH SUPERVISING MECHANICAL ENG R
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