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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS 4 `r r !
JOHN A. L.AMBIE, COUNTY ENGINEER
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE ORITEM
OWNER
WATER CLOSET MAIL
y BATH TUB ADDRESS
SHOWER CITY TEL.NO.
ri LAVATORY CONTRACTOR d
SINK ADDRESS f (?r F .x r- w:' -} ® .•
DISHWASHER CITY ?.;r +±,7 / TEL.NO.
LAUNDRY TUB CONTRACTOR'S A, r STATE
REGISTRATION NO. ._ C? 4°1 COUNTY ❑
CLOTHES WASHER DISTRICT.-4P. GROUP ZONE READY FOR INSPECTION
WATER HEATER
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
APPROVALS
f @ $1.00 PER ITEM DATE INSPECTOR'S SIGNATURE
'! OR FIXTURE $ / � � � UNDER SLAB WORK
f ROUGH PLUMBING , 2,
PERMIT $ 1100
GAS PIPING .Z
TOTAL FEE rU
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.
I HEREBY CERTIFY THAT i AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE UTILITY CO. NOTIFIED
DESCRIBED RESIDENTIAL PROPEJITa(
SIGNATURE
OF PERM ITT EE - �,` FINAL ?,`
ROBERT A. WOOD,
<P,. VALIDATION
SUPERVISING MECHANICAL ENG'R
M. Q. CASH