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APPLICATION FOR PLUMBING PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A LAMBIE COUNTY ENGINEER
CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM 4 '
OWNER
WATER CLOSET MAIL
17
BATH TUB ADDRESS
SHOWER CITY TEL NO
f� LAVATORY CONTRACTOR 1jalley Plumbing Co.
SINK ADDRESS 442 W, FleAtwood
r
DISHWASHER CITY Glendora TEL NO
LAUNDRY TUB CONACTORS REGISTRAT ON NCS 604 COUNTY ❑
CLOTHES WASHER
DISTRI T NOG P ONE READY FOR INSPECTION
WATER HEATER A— J
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
APPROVALS
" @ $100 PER ITEM DATE INSPECTOR S SIGNATURE
OR FIXTURE $ �� UNDER SLAB WORK
PERMIT s 1 00 ROUGH PLUMBING
GAS PIPING
r TOTAL FEE Q GO GAS VENT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES
PLUMBING N
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST jr" r �'
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO NOTIFIED
DESCRIB.D RESIDENTIAL PROPERTY
SIGNATURE
OF PERMITFINAL
TEE � �
ROBERT A WOOD
Ax)(LIDATION SUPERVISING MECHANICAL ENG R
M 0 LASH
s
LACO4059u Au' 20 5 A 1000