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APPLICATION FOOZ PLUMBI G PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
WILLIAM A.JENSEN, 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
LAVATORY CONTRACTOR
SINSzill4k 2
ADDRESS r
DISHWASHER CITY EL. NO.
CON O S STATE
LAUNDRY TUB REGISTRATION NO. COUNTY
CLOTHES WASHER DISTTRI/C�T GROUP I ZONE :71C'ESSEDBY
WATER HEATER L /
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD a
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@ $1.00 PER ITEM
OR FIXTURE $ APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2100 UNDER SLAB WORK <
TOTAL FEE ROUGH PLUMBINGH I � "
GAS PIPING
AHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. HOT WATER HEATER
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS A ELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT I AM THE EGAL OWNER OF ABOVE
DESCRIBED RESIDENTIAL PROPERT . UTILITY CO.NOTIFIED `
SIGNATURE I _
OF PERM ITTE -
FI NAL
®F // VALIDATION ROBERT A. WOOD,
] CK. M.O. CASH SUPERVISING MECHANICAL ENG'R