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APPLICATION FOR PLUMBING PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FNEAREST
ING
ESS s�
JOHN A LAMBIE, COUNTY ENGINEER J
CASSATT D GRIFFIN, SUP T OF BUILDING LITY
FOR APPLICANT TO FILL IN
S ST.
NUMBER FIXTURE OR ITEM
R
WATER CLOSET BATH TUB ESS r
SHOWER CITY TEL.NO.
LAVATORY CONTRACTOR
SINK ADDRESS
DISHWASHER CIT TEL.NO.QS - -3
LAUNDRY TUB CONTRACTOR'S _ STATE
REGISTRATIONNO. O- COUNTY ❑
CLOTHES WASHER
DISTRICT NOGROUP F ZONE I READY FOR INSPECTION
WATER HEATER -5/
' �j /4- 1 f? -3 1
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
v
-7 L
APPROVALS
$1.00 PER ITDATE - INSPECTOR'S SIGNATURE
4 @
OR FIXTURE $ UNDER SLAB WORK
ROUGH PLUMBING
PERMIT S 1 00
GAS PIPING
TOTAL FEE U
GAS VENT
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION HOT WATER HEATER
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES
PLUMBING
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF -
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE UTILITY CO NOTIFIED
DESCRIBLD RESIDENTIAL PROPERTY
SIGNATURE - LCL
OF PERMITTEE FINAL p',l)
O5 ROBERT A WOOD,
VALIDATION- SUPERVISING MECHANICAL ENG R
CK M Os CASH
, 'p
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