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APPLICAT#®N FOR PLUMBING PERWT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS /
CASSATT D. GRIFFIN, Supt of Building LOCALITY
o a-
FOR APPLICANT TO FILL IN y NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM
OWNER
WATER CLOSET MAIL
ADDRESS
BATH TUB
CITY TEL NO.
SHOWER
CONTRACTOR
LAVATORY
SINK ADDR
DISHWASHER CI TEL. NO.
t CONTRACTOR'S Q STATE
LAUNDRY TUB REGISTRATION NO. �l"J COUNTY ❑
CLOTHES WASHER DISTRICTNO. GROUP ZONE PR CESSED BY
WATER HEATER.
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD •'�''
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P FF v
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A
@ $1.00 PER ITEM I /
r OR FIXTURE $ APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
TOTAL FEE biMROUGH PLUMBING
GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. HOT WATER HEATER
-
1 HEREBY CERTIFY THAT I A ROPERLCY REGISTERED AND/OR B PLUMBING FIXTURES
LICENSED AS REQUIRED BY L A ELES COUNTY AND STATE OF GAS TEST
11CALIFORNIA OR THAT 1 A GAL OWNER OF THE ABOVE
DESCRIBED RESIDENTI RTY " UTILITY CO. NOTIFIED
i
SIGNATURE
OF PE RM I TTE
FINAL
OF VALIDATION ROBERT A. WOOD,
cs. M.O. CASH SUPERVISING MECHANICAL ENG'R
FEB 18 A 3 .0 0