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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 En eer ADDRESS
CASSATT D. GRIFFIN, Supt of Building
LOCALrTY r..�..C
FOR APPLICANT TO FILL IN NEAREST P
CROSS ST.
NUMBER FIXTURE OR ITEM OWNS
WATER CLOSET MAIL (�
ADDRESS
BATH TUB
CITY TEL. NO.
SHOWS
LAVATORYCONTRACTOR
ADDRESS
SINK
DISHWASHER CITY TEL NO:
CONTRACTOR'S / STATE
LAUNDRY TUB REGISTRATION NO. / /Y'�'' COUNTY
CLOTHES WASHER DISfT,RII-C--T-NO GROUP I ZONE(
PRO ESSED BY
WATER HEATER v x T /
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
Z Z Ana 64-t
I ® $1 00 PER ITEM
OR FIXTURE $ / APPROVALS DATE INSPECTOR S SIGNATURE
PERMIT $ 2100 UNDER SLAB WORK
TOTAL FEE ? B ROUGH PLUMBING
GAS PIPING b
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING HUT WATER HEATER
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED B 0 ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT M THE LEGAL OW ER OF THE ABOVE
DESCRIBED RESIDENTI PROPERTY UTILITY CO NOTIFIED
SIGNATURE
OF PERMITTE
FINAL AaAA
OF VALIDATION ROBERT A WOOD,
Ca ® o CASH SUPERVISING MECHANICAL ENG'R
JAN 15 5 A 3.0 0 M