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APPLICATION FOR PLUMBING PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County En eer
CASSATT D. GRIFFIN,Supt of Building LOCALITY
FOR APPLICANT TO FILL IN NEARESROSS ST. (> 7 1
NUMBER FIXTURE OR ITEM
OWNER 3. e
WATER CLOSET 11 /+
/ BATH TUB DAD BESS —/ -�ivc ti�sc� st L�
SHOWER CITY eTEL. NO.
LAVATORY CONTRACToFe era
SINK ADDRESS 11 518 LAMLERT AVE. - Gi 3
et Meifffi,
DISHWASHER CITY TEL. NO.
CONTRACTOR'Sd / STATE 2
LAUNDRY TUB REGISTRATION NO. f0 0 J� T COUNTY ❑
I CLOTHES WASHER DISTRICT NO. GROUP P ESSED BY
WATER HEATER ) I
GAS SYSTEM IND TRIAL �2ONE
WASTE APPROVAL
INSPECTION RECORD
L
APPROVALS
OR FIXTURER E DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT2 UU ROUGH PLUMBING
TOTAL FEE GAS PIPING 11
1 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 I AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO.NOTIFIED
DESCRIBED RESIDENTIA PROPERTY.
SIGNATURE , ��� l"� ��I FINAL
OF PERM ITTE
ROBEfrf A.W OD.
®� C—VALIDATION SUPERVISING MECHANICAL ENG'R
C. / Y.O. CASH
I:O�) U 1
1 r .
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