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76A667-CE817 3-5q
APPLICATION FOR PLUMBIN PP'ERMIT '� l
COUNTY OF LOSANGELES
DEPARTMENT OF-COUNTY ENGINEER
BUILDING AND SAFETY DMSION RUILDING
C9rrOHN A.LAMRIE, Couat� er ADDRESS _4%7 -7cf 3,081EAEA def"
11ATT D. GRIFFIN,Supt o!wilding LOCALITY ,
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM OWNER
WATER CLOSET
BATE TUE ADA
DDDRESS S'.�=3 � /� Y.�
CITY STEL,NO.
SHOWER
LAVATORY CONTRACTOR
SINS ADDRESS
DISHWASHER CITY TEL NO.
CONTRACTOR'S STATE ❑
LAUNDRY TUR REGISTRATION NO. COUNTY ❑
CLOTHES WASHER DISTRf� . 1 GROUP ZONE PROCESSED BY
WATER HEATER
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
/c'f T
i � dMa_re AO j A t-
A4 J47,
G $1.00 PER ITEM crlo
ORF $. APPROVALS (' DATE t INSPEC ]S SIGNATURE
PERMIT S 2 00 UNDER SLAB WORK ti
TOTAL FEE G a ROUGH PLUMBING
GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE 1S CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
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CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
S REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
QR THA 1 AM THE LEGAL OWNER OF THE ABOVE
RESIDE PROPERTY. UTILITY CO.NOTIFIEDE / A[iTE
FINAL
®� AI ATION ROBERT A.WOOD,
R.o. DASR SUPERVISING MECHANICAL ENG'$
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