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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGFT•FS
DEPARTMENT OF COUNTY ENGINEER /
BUILDING AND SAFETY' DIVISION 9:7
/OU (/ <JOHN A LAMBIE, COUNTY ENGINEER WILLIAM A JENSEN, SUP T OF BUILDING CFOR APPLICANT TO FILL IN
NUMBER FIXTURE OR ITEM OWNER
WATER CLOSET /7-5 MAIL
BATH TUB J 24- ADDRESS
CITY TEL NO
SHOWER
_ CONTRACTOR
LAVATORY Z S
/ SINS / Z S— ADDRESS 1711112 IV 1� evc eo! Rae
DISHWASHER CXTY/39 161LIJI TEL NO E21VOCONTRACTOG
ATE
LAUNDRY TUB REGISTRATIONNO �Z J S S G COUNTY
CLOTHES WASHER 2 S^ DISTRICT I�LQ_ G77 I'
ZONE PROC O BY
d(�
WATER HEATER �O
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
S INSPECTION RECORD °-
d
N
® $1 00 PER ITEM 9
OR FIXTURE $ / APPROVALS ATE INSPECTOR S 91G 'ATURE
PERMIT 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE // , 2s—
� / r
GAS PIPING G
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 HOT WATER HEATER Y� H
PLUMBING
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES ,e
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 PROPERTYUTILITY CO NOTIFIED (y pL
SIGNATURE41y /
r '
OF PERMITTEE
FINAL
VALIDATION ROBERT A WOOD
cK M O CASH SUPERVISING MECHANICAL ENG R
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