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76A607-CE817 10-60
APPLICATION FOR PLUMBING PERMIT 1
COUNTY OF LOS ANGELES j
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIMION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
WILLIAM A. JENSEN, SUPT OF BUILDING I
LOCALITY
I
FOR APPLICANT TO FILL IN NEAREST '
CROSS ST.
NUMBER FIXTURE OR ITEM OWNER
WATER CLOSET MAIL
BATH TUB ADD
SHOWER CITY o TEL NO.
_
CONTRACTO
LAVATORY Z7,0 _
SINK ADDRESS/'
DISHWASHER CITY TEL. NO.
LAUNDRY TUR NT
REG TRA N NO. / �� ` . ' COUNTY
CLOTHES WASHER DISTRICT NO. • GROUP ZONE (PR SSED BY/� ,
WATERVp
t
GAS SYST INDUSTRIAL
WASTE APPROVAL / -
/ , /INSPECTION RECORD D'
0
z -
U
e $1.00 PER ITEM
OR FIXTURE $ ; APPROVALS DATE , INSPECTOR'S SIGNATURE
PERMIT, S 1 2 100 UNDER SLAB WORK.
TOTAL FEE' ROUGH"PLUMB ING,"
GAS<P_IPING
I HEREBY ACKNOWLEDGE THAT 1 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 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES, -
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL OPS Y.• UTILITY CO NOTIFIED
SIGNATURE
OF PERMITTE
FINAL
'/
' VALIDATION ROBERT A. WOOD
CK. M.O ' CASH SUPERVISING MECHANICAL ENG'R
LACO:5 -2 b._4 OCT. 8 5 D 3.50-