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APPLICATION FOR PLUMBING PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ME'
6)
JOHN A. LAMBIE. County Engineer
CASSATT D. GRIFFIN, Supt of Building
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM
OWNER
71-11- WATER CLOSET
MAIL
BATH TUB ADDRESS
SHOWER CITY TEL. NO.
LAVATORY CONTRACTOR JS
SINK ADDRESS
DISHWASHER CITY TEL. NO. 7`5
CONTRACTOR'S �/ STATE
LAUNDRY TUB REGISTRATION NO. O b O COUNTYEll
CLOTHES WASHER DISTRICT NO: GROUP I ZONE READY FOR INSPECTION
WATER HEATER L
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
V
APPROVALS
@ $1.00 PER ITEM / O b DATE INSPECTOR'S SIGNATURE
OR FIXTURE
UNDER SLAB WORK i
PERMIT $ 00 ROUGH PLUMBING
TOTAL FEE 0 GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. PLUMBING FIXTURES
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST -
LICENSED AS REQUIRED BY S ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I T LEGAL OWNER OF THE ABOVE UTILITY CO.NOTIFIED
DESCRIBED RESIDENTIAL TY.
SIGNATURE
OF PERMITTE FINAL
1
ROBERT A.WOOD.
®� VALIDATION SUPERVISING MECHANICAL ENG'R
CK. M.O. CASH
2 7 7 1°; FEB 2rj 5 A 8.00