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APPLICATION FOR LIJMI11G PERMIT �
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A LAMBIE, County. Engineer ADDRESS
CASSATT D GRIFFIN, Sup t of Building / y
LOCALITY �/ Z
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM
OWNER ,tom
WATER CLOSET MAIL
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BATHTUB ADDRESS '" 9
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SHOWER CITY TEL NO.
LAVATORY CONTRACTOR IEZLUjy
SINK ADDRESS /9 0j Z'%
DISHWASHER CITY .. TEL. NO.
CONTRACTOR S STATE ❑
LAUNDRY TUB REGISTRATION NO. �� P rf COUNTY ❑
CLOTHES HEATER ER DISTRICT NO GRZONE PRt�CESSED BY
WATER
GAS SYSTEM INDUSTRIAL!—
WASTE APPROVAL
INSPECTION RECORD
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-22 -6 .9 v o5,p F< o 6�-x-T
W,
D OR FIXTUR1 00 PER E $
APPROVALS DATE INSPECTOR S SIGNATURE
PERMIT $ 2 00 t UNDER ORK
TOTAL FEE / a ROUGH PLUMBING
GAS PIPING
I HEREBY ACKNOWLEDGE THAT I 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 HOT WATER HEATER n
PLUMBING
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ��/" �
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE GAS TEST rCl e�[.�As
DESCRIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED
SIGNATURE / " /// ✓�� /J
OF PERMITTEE ((( _/1
FINAL
®P AUDATION ROBERT A WOOD,
CK H 0 CASH SUPERVISING MECHANICAL-ENG'R