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APPLICATION FOR PLUMBING PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING (p'D�
JOHN A. LAMBIE, Count Engineer ADDRESS
CASSATT D. GRIFFIN,Sup t of Building LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM OWNER
WATER CLOSET ,r
BATH TUB ADDRESS CO v2 Y
CITY -t TEL. NO.
SHOWER
LAVATORY CONTRAC OR
SINS ADDRESS N
DISHWASHER CITY TEL. NO.
CONTRACTOR'SSTATE El
LAUNDRY TUB REGISTRATION NW/
COUNTY [I
CLOTHES WASHER DISTRICT N GROUP RNE, CESSED BY
WATER HEATER
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
APPROVALS
U PER
OR $ /00
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT 51 2100 ROUGH PLUMBING
-TOTAL FEE O GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 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 RESIDENTIAL PROPERTY.
SIGNATURE C/�(/J
OF PERMITTEE L�fiL�JV FINAL i
ROBERT A.WOO&.
®� VALIDATION UPERVISING MECHANICAL ENG'R
CK. M.0. CASH
; ' 7298 JUN 1 5 A 3 .00 M :,