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APPLICAPION FOR PLUMBING *RMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAFIDIE, CountF Enginoer ADDRESS
CASSATT D. GRIFFIN, Sup t of Building LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM
^ OWNERC
O WATER CLOSET MAIL
/ BATH TUB ADDRESS
SHOWER CITY TEL. NO.
LAVATORY CONTRACTORVal IfPlumbing _
/
SINK ADDRESS d
DISHWASHER CITY "nra TEL. NO.
CONTRACT A'S
Ed �mWg
LAUNDRY TUB REGISTRATION NO. COUNTY ❑
CLOTHES WASHER DISTRICT NO. GROUP ZONE PRPCESSED BY
WATER HEATER 1 y
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
//// APPROVALS
�G @ ER ITEM
OR FIXTURE $ ��--�� DATE INSP TOWS SIGNATURE
UNDER SLAB WORK -1A'-,,"e9,
PERMIT $ 2100 ROUGH PLUMBING
TOTAL FEE GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. PLUMBING FIXTURES
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANDGAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 M TH LEGAL OWNER OF THE ABOVE UTILITY CO.NOTIFIED
DESCRIBED RESIDENTIA OPE Y.
I.
SIGNATURE G FINAL V
OF PERMITTE
ROBERTA.WOOD.
®r VALIDATION SUPERVISING MECHANICAL ENGR
cK. M.o, cASH
A 6087E FEB 4 5 A 12
2.00
i���n�vN.AitN/