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APPLICATION FOR *.PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING A -7
JOHN A. LAMBIE, County Engineer ADDRESS
CASSATT D. GRIFFIN,Suet of Building
LOCALITY
FOR APPLICANT TO FILL IN CREOSSSTT. i
NUMBER FIXTURE OR ITEM - - a
• OWNER
WATER CLOSET ✓ MAIL
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BATH TUB ADDRESS
CI ` °�( TEL. NO. 7 q S'3
SHOWER Z l
LAVATORY CONTRACTOR
1/4
SINS ADDRESS r=!
DISHWASHER CITY _J�TEL. NO.
CONTRACTOR'S f STATE ❑ `?
LAUNDRY,TUB _ REGISTRATION NO. COUNTY :❑ s
CLOTHES WASHER GROUP
.a-,,,.•:. E _ l -,; E '
^L DISTRICT NO. GROUP ZONE P ESSED BY
WATER HEATER K
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
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APPROVALS
@ OR F ER ITEM
F $ 13
� DATE INSPECT-0 S,SI'GNATURE
/ UNDER SLAB WORK
PERMIT $ 2100 .r ROUGH PLUMBING /Z-1!-a`) L Y--,oR
TOTAL FEEaa 40r' GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION , GAS VENT �j y/' J
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY o
HOT WATER HEATER
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING, s PLUMBING FIXTURES a.
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR k 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 RESIDENTI -- PROPERTY. rs 'ice
SIGNATURE
OF PERM ITTE FINAL'
as s . ;: q..,•.r @; ROBERT A.WOOD.
®F• VALIDATION SUPERVISING MECHANICAL ENG'R
CK. Id.w0. CASH