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APPLICATION FOR PLUMBING PERMITCOUNTY OF LOS ANGELES
1
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING O ,.3 r
TOHN A. LAMBIE, CountF Eng�oer ADDRESS
CASSATT D. GRIFFIN,Sup I oI BuUdin3
LOCALITY ,e n2 / C
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM
OWNER
WATER CLOSET MAIL
BATH TUB ADDRESS
SHOWER CITY - TEL. NO.
LAVATORY CONTRACTOR T { !//Y,,6 �L
SINB ADDRESS D
DISHWASHER CITY D.t//I U rJ TEL. NO.j6; pYe2�
CONTRACTOR'S STATE
LAUNDRY TUB REGISTRATION NO. Q O COUNTY
/ CLOTHES WASHER DISTRIC O. GROIJp ZQNE I P OCESSED BY
WATER HEATER yr ;4
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
APPROVALS
OR ITEMFIXTURE $
@ PER EM Q V DATE INSPECTOR'S SIGNATURE
OR V
UNDER SLAB WORK
PERMIT $ 2100 ROUGH PLUMBING
TOTAL FEE QD GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT
IT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER -f
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. PLUMBING FIXTURES /
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE UTILITY CO.NOTIFIED
DESCRIBED RESIDENTIAL ERT
OF PERMITTE
SIGNATURE FINAL . -/
ROBERT A.WOOD.
®� VALIDATION SUPERVISING MECHANICAL ENG'R
CR. 8.0. CASH
iA04 8 8 0 A?R 13 5 A 9.00 m