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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIMION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
WILLIAM A. JENSEN, SUPT of BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEW T.
NUMBER FIXTURE OR ITEM OWNER
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WATER CLOSET MAM
BATH TUB ADDRESS
CITY TEL NO.
SHOWER ,Z
LAVATORY D CONTRACTOR
.- SING: .- ADDRESS C �, hh
DISHWASHER CITY Wi a TEL. NO. �!J
- CONTRACTOR'S STATE
LAUNDRY TUB REGISTRATION NO. Q COUNTY
CLOTHES WASHES 1 ,25 DISTRICT NO. GROUP I ZONE PSSED BY
WATER HEATER 150 1 � "— d
INDUSTRIAL O
GAS SYSTEM WASTE APPROVAL �
' INSPECTION RECORD? R 0
O
Lu
O $1.00 PER ITEM
OR FIXTURE $ APPROVALS DATEI INSPECTog•S SIGNATURE
PERMIT $ 2100 UNDER SLAB WORK
r
TOTAL FEEROUGH PLUMBINGLs 1St:
® GAS PIPING
1 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 k
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST l .7
CALIFORNIA OR THAT 1 AM THE LEG L OWNER OP THE ABOVE
DESCRIBED RESIDENTIA PROPERTY. UTILITY CO. NOTIFIEDIl
SIGNATURE I
OF PERMITTE r
FINAL 0A
VALIDATION ROBERT A. WOOD
M.9. CASH SUPERVISING MECHANICAL ENG•R
3538 DEC16 5 D 15.00-