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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING y� /
JOHN A. LAMBIE, County.Engineer ADDRESS
CASSATT D. GRIFFIN, Sup t of Building
LOCALITY �C��
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FOR APPLICANT TO FILL IN NEA 3SST. 1
NUMBER FIXTURE OR ITEM
WATER CLOSET OWNERMAIL / w N �-7�
BATH TUB ADDRESS
SHOWER CITY TEL. NO.
LAVATORY CONTRACTOR ' —
SINK ADDRESS r%
DISHWASHER CITY TEL. NO.
LAUNDRY TUB CONTRACTOR'S STATE [I
REGISTRATION NO. COUNTY ❑
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CLOTHES WASHER DISTRICT NO: GaQLLP gE, READY FOR INSPECTION
WATER HEATER
-r. GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
APPROVALS
@ $1.00 PER ITEM DATE INSPECTOR'S SIGNATURE
[AA OR FIXTURE $ ; UNDER SLAB WORK
PERMIT $ 00 ROUGH PLUMBING
TOTALFEE O/1 GASPIPING EBY .ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIONGAS VENT
TE THAT THE ABOVE IS CORRECT AND AGREE TOCOMPLY - HOT WATER HEATER
LL COUNTY ORDINANCES AND STATE LAWS REGULATING
NG. PLUMBING FIXTURES
EBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST
D AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
NIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO. NOTIFIED
ED RESIDENTIAL PROPURERMITFINALROBERTA.WOOD.®F VALIDATIb SUPERVISING MECHANICAL ENG•R
F
CK. M.0. CASH
3.0
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