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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING� LQ����
JOHN A LAMBIE CountF Enggineer
CASSATT D GRIFFIN, Sup t of Buildhng
' LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM i
OWNER
WATER CLOSET MAIL
BATH TUB ADDRESS
SHOWER CITYZWdZ
TEL NO
LAVATORY CONTRACT
SINS ADDRESS �� �
DISHWASHER CITY TEL NO 3��0 7,
LAUNDRY TUB CONTRACT 7 STATE
REGISTRAT ON NO COUNTY ❑
CLOTHES WASHER DISTRICT NO GROUP P �SSED
WATER HEATER Z E E
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
APPROVALS
ER
FIXTURE $ I /
DATE INSPECTOR S SIGNATURE
UNDER SLAB WORK
PERMIT $ 2 00 ROUGH PLUMBING
TOTAL FEE f pU GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING PLUMBING FIXTURES
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO NOTIFIED
DESCRIBED RESIDENTIAL PROPERTY
SIGNATURE
OFPERMITTEE �'—V FINAL 4-?'6 0 �y
ROBERT A WOOD
OF VALIDATION SUPERVISING MECHANICAL ENG R
CK m O CASH
2055SEP 2 5 A 3,.0 0 0