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76A667-CE817-11-57
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County, Engsneer ADDRESSICOUNTY
CASSATT D. GRIFFIN, Supt of BuildingLOCALITY
FOR APPLICANT TO FILL IN NEARESTCROS ST.NUMBER FIXTURE OR ITEM
WATER CLOSET OWNEWJJ�'MAIL
BATH TUB ADDRESS l6aSHOWER CITY TEL. NO.LAVATORY CONTRACTOSINK ADDRESS
DISHWASHER CITY TEL. NO.
CONTRACTOR'S LAUNDRY TUB REGISTRATION NO.
CLOTHES WASHER DIS NO: GROUP ZONE READY FOR INSPECTION
WATER HEATER
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
APPROVALS
PER ITEM DATE INSPECTOR'S SIGNATURE
OR FIXTURE $ '/ 00
UNDER SLAB WORK
PERMIT $ ` 00 ROUGH PLUMBING
TOTAL FEE C>6 GAS PIPING
I HEREBY ACKNOWLEDGE THAT I .HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING -
PLUMBING. PLUMBING FIXTURES
1 HEREBY CERTIFY THAT I AM. PROPERLY REGISTERED AND/OR GAS TEST /fl/yt} 1 -ST G'�fjjzdt ntr
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 PROPER Y.
SIGNATURE /n/� ��(n\� v �!
- OF PERMITTE K-^ V`.V /��/�� FINAL 62 �,f• 1 f j
ROBERTA.WOOD.
OF VALIDATION SUPERVISING MECHANICAL ENG'R
CK. H.0. CASH - .a
t - e'� :QCT 3 5-
/ 1 ���