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APPLICATION FOR PLUMBING PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING ,& eR 40� r1 kj
JOHN A. LAMBIE, County Engineer ADDREBS n IT
CASRATT D. GRIFFNJ. Supt of Building
LOCALITY T �.... :
FOR APPLICANT TO FILL IN NEAREST [�
NUMBER FIXTURE OR ITEM CROSS ST. ✓r1
I WATER CLOSET OWNER G C- ,4 D
AII
BATH TUB r,C v ADDRESS
I
SHOWER CITY TEL. NO.
( LAVATORY G CONTRACTOR ff Qtv '}' o
J
SINK ADDRESSL4I D Sf ,4 I> pVr ,I�
DISHWASHER CITY )ttTEL. NO ay Z 4 D�I'
CONTRACTOR'S / // �J STATE
LAUNDRY TUB REGISTRATION NO. OIL' Q COUNTY ❑
CLOTHES WASHER DISTRICT O. GROUP ZONE aEAOT FOa INSPEciION
WATER HEATER Ik
GAS SYSTEM O INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
APPROVALS
FD[ EM DATE INSPECTOR'S SIGNATURE
O1.R 0 PER R TEIT. S ll
/'J UNDER SLAB WORK 3-/J-S`�/ ydll+.a+-��
PERMIT $ 2 0000-- ROUGH PLUMBING
TOTALFEE A1C 0✓ GASPIPING y/ �"`L^-e`-✓
I HEREBY ACKNOWLEDGE THAT 1`9AVE READ THIS APPLICATION GASVENT
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY HOT WATER HEATER
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. PLUMBING FIXTURES 1 /V
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GASTEST
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 RESIDENTIA IROPERTY.
SIGNATURE
OFPERMITTE FINAL
ROBERTA.WOOD.
®' VALIDATION SUPERVISING MECHANICAL ENG-k'
CG.
H.0. CASH
I:ro3 3,1 0 & rA 11 5 A 9.00 M