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APPLICATION FOR PLUMBING ERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS j
WILLIAM A. JENSEN, SUPT OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN NEAREST ' r�
CROSS ST.
NUMBER FIXTURE OR ITEM OWNER
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WATER CLOSET MAIL
BATH TUB ADDRESS
CITY TEL. NO.
SHOWER
LAVATORY CONTRACTOR
SINK ADDRESS L ✓F
DISHWASHER CITY — G NO.
CONTRA OR's STATE
LAUNDRY TUB REGISTRATION NO. COUNTY
CLOTHES WASHER DISTRICT NO. I GROUP ZNE I ROC ED Y
WATER HEATER
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD >.-
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PER ITEM
OR / nO
OR FIXTURE $ (i APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2100 UNDERSLgff�WORK
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TOTAL FEE
ROUGH PLUMBING `
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GAS PIPINGn-
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLYGAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. HOT WATER HEATER
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT I AM TH LEGAL OWNER OF THE ABOVE „
DESCRIBED RESIDENTI)L PROPE UTILITY CO.NOTIFIED
SIGNATURE '? I
OF PERMITTE FINAL
®r 0VALIDATION ROBERT A. WOOD,
Cs. M.0. CASH SUPERVISING MECHANICAL ENG'R
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