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APPLICATION FOR PLUMBING PERMIT �
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING
JOHN A LAMBIE County Engmeer ADDRESS
CASSATT D GRIFFIN Sup t of Building
ympaRsEmmm LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
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NUMBER FIXTURE OR ITEM r
OWNER
WATER CLOSET MAIL
BATH TUB ADDRESS
SHOWER CITY TEL NO
LAVATORY
CONTRACTORXj r.
Sm ADDRESS —S AA Ci.6
DISHWASHER CITY 0 ✓(a_ TEL NO ly S-,21 D
CONTRACTOR S STATE
LAUNDRY TUB REGISTRATION NO / 3 Ca COUNTY
CLOTHES WASHER DISTRICT NO GROUP I Z NE PROCESS Y
WATER HEATER
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
0 INSPECTION RECORD
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Q 51 DOPER ITEM
I! OR FDCTURE $ /! ✓ APPROVALS DATE INSPECTOR S SIGNATUR
PERMIT $ 2100 UNDER SLAB WORK �C IZI
P�tNt�
TOTAL FEE O v ROUGH PLUMBING p,`
GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING HOT WATER HEATER Af
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES (Gl
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST C4/
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERT UTILITY CO NOTIFIED
SIGNATURE t
OF PERMITTE
FINAL
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®r VALIDATION ROBERT A WOOD
CE ® 0 CASH SUPERVISING MECHANICAL ENG R
L�Gc,os891 7 5 A 13 0 0 U
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