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APPLICATION FOR PLUMBING •PERMIT �
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING 'f
JOHN A. LAMBIE, County En ineer ADDRESS v
CASSATT D. GRIFFIN, Supt of Building '
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM OWNER "
"_ WATER CLOSET MAIL
ADDRESS
BATH TUB
CITY TEL. NO,
SHOWER y
LAVATORY CONTRACTOR
p Sm, ADDREss
I DISHWASHER CITY / /� TEL NO.
CONTRA
TOR'S
STATE
LAUNDRY TUB REGISTRATION NO, / -[ COUNTY
CLOTHES WASHER DISTRICT O. GROUP �epE' O ESSED'ABY,
WATER HEATER
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
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$1.00 PER ITEM I / / / /7-/! A I-)M, s
OR FIXTURE $ APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2100 UNDER SLAB WORK
TOTAL FEE ROUGH PLUMBING 1-H '--81 ��F'!r
GAS PIPING /
I D HEREBY ACKNOWLEDGE THAT '1 HAVE READ THIS APPLICATION GAS VENT
ANSTATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. HOT WATER HEATER h/}.�!-A /✓1)
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES '"tdO W6.1J1/L�Q'
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF E ABOVE _
DESCRIBED RESIDENTIAL OPERTY. UTILITY CO NOTIFIED /�
SIGNATURE ��/Jt�.�C�C. 4� S "
OF PERMITTE LL z FINAL
®F ALIDATION ROBERT A. WOOD,
M.o. cesR SUPERVISING MECHANICAL ENG'R
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