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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 ENGINEER ADDRESS
WILLIAM A. JENSEN, SUPT OF BUILDING
LOCALITY
FOR APPLICANT TO FELL IN NEAMT
CROSS ST.
NUMBER FIXTURE OR 8M OWNER b
L WATER CLO / d MAIL
BATH TUB S ADDRESS
Cm TEL NO.
SHOWER
LAVATORY '7i S CONTRACTOR
SINK ADD
2_
DISHWASHER Cm . NO. ICOUNTY O S LAUNDRY TUB REGISTRATION NO.
CLOTHES WASHER �, ;,) DISTRIY O GROU,P ZONE
8 Y
WATER NEATER
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL r
1 1 INSPECTION RECORD O
a
z
z
0R ITEM _1 C
i�URE $ / '1 APPROVALS PATE INSPECTOR S SIG;lA7qRE
PERMIT $ 2100 UNDER SLAB WORK G,:. �•Gi ?'
TOTAL FEE �- ROUGH PLUMBING • y.� ,/
GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT A
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. HOT WATER HEATER
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANDIOR PLUMBING FIXTURES (I / G`"' ✓ ,A
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OP GAS TEST
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO. NOTIFIED
61 1 OF PERMITTE
FINAL
MIMATION ROBERT A. WOOD
crc.
M.0. CASH SUPERVISING MECHANICAL ENG'R
L4E02 6 5 9% AUG 7 5 D 1 5.00~/V