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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER +� /'
BUILDING AND SAFETY DIVISION ADDRESS y �J
1
JOHN A: LAMBIE, County. Engineer 0 '
CASSATT D. GRIFFIN, Supt of Building
LOCALITY ��• _
FOR APPLICANT TO FILL IN NEAREST G,
CROSS
NUMBER FIXTURE OR ITEM
WATER CLOSET OWNER <
BATH TUB ADDRESS -
SHOWER CITY TEL NO. V 40
LAVATORY CONTRACTOR CAI 41Q�
SINS ADDRESS
DISHWASHER CITY TEL. NO. s( 7 7 3�(p
CONTRACTOR'S �J (� C 4 STATE 01LAUNDRY TUB REGISTRATION NO. `/ O 3 ` COUNTY
CLOTHES WASHER DISTRICT N l GRO /ZONE READY FOR INSPECTION
WATER HEATER
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
1 P I cz)w--
APPROVAL v
/1 0 $1.00PER ITEM DATE INSPECTOR'S SIGNATURE
It OR FDCTURE $ ,d p c)
UNDER SLAB WORK '
PERMIT 00 ROUGH PLUMBINGR-'! SIC•
TOTAL FEE ( C) 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 1 AM PROPERLY REGISTERED AND/OR GAS TEST i ].
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF _
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO NOTIFIED U
DESCRIBED RESIDENTIAL PROPERTY.
SIGNATURE r FINAL
OFPERMITTEE 4
ROBERTA.WOOD.
®FVALIDATION SUPERVISING MECHANICAL ENG'R_
CK. M.O.