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76A667-CE817-8-57
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APPLICATION FOR PLUMBING PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING J
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
4 CROSS ST.
NUMBER FIXTURE OR ITEM
OWNER
WATER CLOSET MAIL
f BATH TUB ADDRESS
SHOWER CITY TEL.NO.
LAVATORY CONTRACTOR aNW- -9. (/✓/�arp rill�
r SINK ADDRESS
DISHWASHER CITY TEL.
LAUNDRY TUB CONTRACTOR'S STATE
REGISTRATION NO. COUNTY
CLOTHES WASHER
DISTRICT NO. G 'f'7�JP ZONE READY FOR INSPECTION
WATER HEATER / _
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
f
APPROVALS
DATE INSPECTOR'S SIGNATURE
@ $1.00 PER ITEM
OR FIXTURE $ 4:57 UNDER SLAB WORK
ROUGH PLUMBING
PERMIT S 1 00
GAS PIPING .:
TOTAL FEE 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. r
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY ELES COUNTY AN S TE OF .?.
CALIFORNIA OR THAT I EG OF T ABOVE UTILITY CO. NOTIFIED
DESCRI BLD RESIDENTIA P
SIGNATURE
OF PERM ITTEE FINAL
ROBERT A. WOOD,
o�, ALIDATION
SUPERVISING MECHANICAL ENG'R
CN. M.0. CASH
.AC0 3 3 4 4°° .l. 3 0 5 A 8.0