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APPLICATION FOR PLUMBI G PERNIM
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COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEERZcRoss
BUILDING
BUILDING AND SF gTY DIVISIONESS
JOHN A LAMBIE OUNTY ENGINEER
WILLIAM A JENSEN SUPT OF BUILDINGLITY
FOR APPLICANT TO FELL IN EST
ST
NUMBER FIXTURE OR ITEM OWNER
WATER CLOSET MAIL
ADDRESS
BATH TUB
CITY TEL NO Z
SHOWER
CONTRACTOR
of LAVATORY
/ ADDRESS
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DISHWASHER CITY9 TEL NO 7 Z 3
CONTRACTORS jTATF
LAUNDRY TUB REGISTRATION NO NTY
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CLOTHES WASHER DISTRICT NO GROUB- ZONE PRO5pS BY
WATER HEATER ✓ •/ �
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD w
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$1 00 PER ITEM
OR FDCTURE $ OQ APPROVALS QATF, INSPECTOR
/)S'SIGNATURE
PERMIT $ 2 00 LINDER�frB"WORK ,I -m
TOTALFEE ROUGH PLUMBING I`-.2.r-6 ���, 1,
0 o—L� GAS PIPING �? l�,Ir-rsim�-I
I HEREBY ACKNOWLEDGE THAT I 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 HOT WATER HEATER
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES i
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE GAS TESTp�
DESCRIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED cy", i �
SIGNATURE A
OF PERMITTE _ FINAL
Or ALIDATION ROBERT A WOOD ..
ca m 0 CASH SUPERVISING MECHANICAL ENG R
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