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APPLICATION FOR PLUMBING PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION ADDRESS SryIOHN A. LAMBIE, County Eng�'neerGASSATT D. GRIFFIN, Sup I o2 Bilding LOCALITYFOR APPLICANT TO PILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEMOWNERWATER CLOSET MAIL
BATH TOB ADDRESS
CITY il
SHOWER LLAVATORY CONTRACTOR L L46SINK ADDRESS o✓ s ✓DISHWASHER CITY � ' O3CONTRAC OR'S STATELAUNDRY TUB REGISTRATION NO. OUNTY ❑CLOTHE$WASHER DISTRICT NO. GROUP SSED BY
WATER HEATER y ,
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
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�•.e�" 1 APPROVALS `fel
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OR FIXTURE $
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DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT S 2100 ROUGH PLUMBING
TOTAL FEE d GAS PIPING ✓ _�-
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT )
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER X u
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. PLUMBING FIXTURES I
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR 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 9-If_f'/
DESCRIBED RESIDENTIA TY. r
SIGNATURE FINAL (CA•'•Y---
OFPERMITT
ROBERT A.WOOD.
®r OVALIDATION SUPERVISING MECHANICAL ENG'R
CK. M.O. CASH
kCoasa1 Artl13 5 A 9.00 F