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APPLICATION FOR PLUMBINGPERX r �,
COUNTY OF LOS ANGELES y �
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 ES
IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM
OWNER
WATER CLOSET M
BATH TDB AIL
ADDRESS
CITY TEL. NO.
SHOWER
LAVATORY CONTRACTOR
SRQE ADDRESS /y /T
DISHWASHER CITY CONTILAulvab
GP LQ 3
LAUNDRY TDB REGISTRATION NO. COUNTY]
STATE
o y�� CGDNTY e
CLOTHES WASHERDIST�TNOJ GR ZONE PROC S BY
WATER HEATEB [9
7 k
GAS SYSTEM INDUSTRIAL
A
RAPPROV
/INSPEClfON 0
a
z
z
® $1.00 PER ITEM
OAFIXTUAE $ / APPROVALS DATE INSPECTORS SIGNATURE
PERMITS
. 100 UNDER SLAB WORK
TOTAL FEE � ROUGH PLUMBING
GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IB CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. HOT WATER HEATER
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COU TY ANO STATE OF n
CALIFORNIA OR THAT I AM THE LEGAL OW R OP ABOVE GAS TEST
DESCRIBED RESIOENTIAL PROPERTY. UTILITY CO. NOTIFIED �, f ���
SIGNATURE _ 1 I1 r .-41I � IY
OF PERMITTE CC.�� (q
FINAL I Y 1 �I flrYp
/
VALIDATION ROBERT A.'W066
«/ cM.O. GSH SUPERVISING MECHANICAL ENG'R
5656: DEC 1 5 0 3.00 M