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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE. County Engineer ADDRESS
CASSATT D. GRIFFIN, Sup't of Building
LOCALITY ..o
FOR APPLICANT TO FILL IN NEAREST
CROSS ST. _
NUMBER FIXTURE OR ITEM
OWNER
WATER CLOSET MAIL
ADDRESS 124
w �IeGS Aye.
BATH TUB
CITY TEL. NO.
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LAVATORY CONTRACTOR -1 �7 _ n
q.
i SING ADDRESS
DISHWASHER CITY WV
CONTRACTOR'S'^ E xQ
LAUNDRY TUB REGISTRATION NO. "< t COUNTY '
CLOTHES WASHER DISTRICT NO. GROUP I ZONE I PROCESSED BY,
WATER HEATER
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
PER ITEM
OR FIXTURE APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2100 UNDER SLAB WORK
TOTAL FEEROUGH PLUMBING
` �� GAS PIPING
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 I 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 PROPERTY. UTILITY CO. NOTIFIED
SIGNATURE
OF PERMITTEE
FINAL
OF VALIDATION ROBERT A. WOOD,
CK. M.0. CASH SUPERVISING MECHANICAL ENG'R