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APPLICATION POR UBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT-OF COUNTY ENGINEER
BUILDING ANDES gTY RIVISION BUILDING f / /
JOHN A. LAMBI ouNTY NGINEER ADDRESS �1
WILLIAM A. JENSEN, SUPT OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM
OWNER
WATER CLOSET MAIL
BATH TUB ADDRESS
CITY TEL. NO.
SHOWER
LAVATORY CONTRACTOR
p SINK ADDRESS /
DISHWASHER CITY -r�_�YCTt �( TEL. NO -
CONTRACTOR'S STATE
LAUNDRY TUB REGISTRATION NO. J COUNTY ❑
CLOTHES WASHER DISTRICT NO. GRQb4-'I ZONE I P CESSED BY
WATER HEATER
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
6o F
/ 1_•.
!? $I.00 PER ITEM I �} /2 "6 �is1 A ... 'iQ+_-
OR FIXTURE � v APPROVALS DATE V
$ INSPECTOR'S SIGNATURE
PERMIT $ 2100 UNDER SLAB WORK
TOTAL FEE ROUGH PLUMBING
GAS PIPING
1 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
PLUMBING. HOT WATER HEATER
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTI PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE
OF PERMITTEE
FINAL
Or ALIDATION ROBERT A. WOOD,
CC. M.0. CASH SUPERVISING MECHANICAL ENG'R