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APPLICATION FO PLUMBING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN I PRINT OR TYPEI BUILDING
NUMBER FIXTURE OR ITEM ® FEE ADDRESS
WATER CLOSET LOCALITY
NEAREST
BATH TUB GROSS ST.
SHOWER OWNER
LAVATORY ADDRESS '1 Y\
SINK CITY ; L.N •�
DISHWASHER CONTRACTOR
CLOTHES WASHER ADDRESS
SWIMMING POOL RECEPTOR
CIT TEL.NO
LAWN SPRINKLER SYSTEM
STATE LIC.
WATER HEATER LICENSE NO. CLASS
GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR'S SIGNATURE
OUTLETS OVER UNDERSLAB WORK
5 PER SYSTEM ROUGH PLUMBING
Y
GAS PIPING
O
GAS VENT V
lu
HOT WATER HEATER p0p.
PLUMBING FIXTURES p L[ U
GAS TEST �.S /".? I(l(�61 N 7r WWF
N
Plan check fee UTILITY C0
PLUMBING PERMIT ISSUING FEE$ 506 Q RE ZN�
TO7AL FEE i FINAL
Ploo check applicant i PLAN
—CHECK
�VALIDATION
Nome
Address S'V'7p � !1(
Of Tel,No 4t?.5-TZ�s7'' NGS-tidy �A(U4::L,ya 71S!`E '-
1 HEREBY ACKNOWLED E THAT I HAVE READ THIS APPLICATION AND STATE ``[(
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES v 4 6 3 0 A
AND STATE LAWS REGULATING PLUMBING, PERMIT VALIDATION q
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS # O O O O O 5
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE
LEGAL OWNER OF,AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL 2 - - 1 (100
SIGNATURE,PROPERTY. //.� TI.\1��^T{� `1�\ �y� 'O O - 10005
OFFER
DISTR FIROCESSE B 0 630-79
INDUSTRIAL
WASTE APPROVAL
7RAS67-CESI7 3-59
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING .�
JOHN A. LAMBIE, County Engineer ADDRESS / p
CASSATT D. GRIFFIN. Supt of Building LOCALITY t/
FOR APPLICANT TO FILL IN NEAREST
CROSS ST. e>`
NUMBER FIXTURE OR ITEM
OWNER
WATER CLOSET MAIL
/ HATH TUB ADDRESS
SHOWER CITY TEL. NO.
LAVATORY CONTRACTOR rT
/
SIN$ ADDRESS ') QI /C
DISHWASHER crrY AI o,�/* U TEL NO. 82/03
CONTRACTOR'S STATE
LAUNDRY TUB REGISTRATION NO. (] O COUNTY
CLOTHES WASHER DISTRICTNO. GROUP //ZZOONE P CESSED BY
WATER HEATER V\—
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
("RcT/ROJV -1-0-J'WrH
$I.DD PER ITEM ��,4 O. 1 /JbR/ ryin -l# ) byn
/
OR FIXTURE $ /97 0 APPROV Q DATE INSPECTOR'S SIGNATURE
PERMIT $ 2100 UNDER5 WORK n '—//- .(�/1'/�e J12.O/-m
TOTAL FEE O d ROUGH PLUMSINGTt/' �L�/'/ l/'}3.'fi�.Y41%J,l4.il/YA
O� GAS PIPING -lam v�Xfhllif11�U4'/
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT f�,N YIUA 19�/
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER - 14J
PLUMBING.
1 HEREBY CERTIFY THAT' 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES JU l w/
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OP GAS TEST L
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF T ABO E
DESCRIBED RESIDENTIAL P UTILITY CO. NOTIFIED f>•/
SIGNATURE
OF PERMITT pp
FINAL
®r VALIDATION ROBERT A. WOOD,
cc. m.0. CASH SUPERVISING MECHANICAL ENG'R
7447E 3111ft 8 5 A 12.00