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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. En eer ADDRESS
CAS3ATT D GRIFFIN Sup of Building LOCALTPY
FOR APPLICANT TO FILL IN NEARESTCROSS / r
NUMBER FIXTURE OR ITEM '
OWNER �� J
WATER CLOSET MAIL
BATH TUB ADDRESS
CITY �y17
SHOWER �A TEL NO
LAVATORY CONTRACTOR
ADDRESS
SINS
DISHWASHER CITY TEL NO -4— c�`
CONTRAC 3STATE
LAUNDRY TUB REGISTRATION NO 11 COUNTY
CLOTHES WASHER DISTRICT NO GROUP ZONE P ESSED BY
WATER HEATER 0 0
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
2-25`-Aet= 'Ax-
WS AIFFDgb Zd
Q 51 00 PER ITEM
OR FDCfURE $ APPROVALS DATE INSPECTOR S SIGNATURE
PERMIT $ I 2100 UNDER SLAB WORK
TOTAL FEE Qg OJ ROUGH PLUMBING
GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 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
L
CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
OR THAT 1 AM THE� LEGAL OWNER OF THE ABOVE
ESIDENTIAL/ ROP TY UTILITY CO NOTIFIED
/TE
FINAL 3—Z/
OF VALIDATION----, ROBERT A WOOD
CK H O C CASH SUPERVISING MECHANICAL ENG R
`s, r,G894� FEB 5 A OQ