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COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE, County Engineer
CASSATT'D. GRIFFIN, Supt of Building LOCALITY
C
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM -
OWNER
WATER CLOSET MAIL
ADDRESS
BATH TUB
CITY TEL NO.
SHOWER
LAVATORY CONTRACTOR —
SINS ADDRESSAl �n1 w, `
DISHWASHER CITY 0 TEL NO. �xlO3
CONTRACTOR'S STATE
LAUNDRY TUB REGISTRATION NO. COUNTY
CLOTHES WASHER DISTRIC?NO. GROUP %E P CESSED BY
WATER HEATER ti Y
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
/// INSPECTION RECORD
ee'
R Worm
ITEM J
"R FDCTQSE $ / 2 O O APPROV 8 �pzvo DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER S WORK d-
TOTAL FEE ! t� GJ ROUGH PLUMBING
GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. HOT WATER HEATER
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AHD/OR PLUMBING FIXTURESLICENSED ANGELES COUNTY AND n
OF
CALIFORNIASORETHATDI BAMLOS THE LEGAL OWNER OF THEATE ABOVE GAS TEST ZMM �gsj
DESCRIBED RESIDENTIAL P PE UTILITY CO NOTIFIED
j SIGNATURE
OF PERM ITTE V
b FINAL 9
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CAlEATION ROBERT A. WOOD.. CASH SUPERVISING MECHANICAL ENG'R
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