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APPLICATION _F'OR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGII�iEEB
BUTT.DII�iG AN�D�SAFETY DMSION soannra
JOHN A LAM 1 COUNTY ENGINEER ADDRBSS
WILLIAM A JENSEN. SUP T OF BUILDING LOCK= e
FOR APPLICANT TO FILL IDN CNCAMT
ROSS ST
NUMBER FIXTURE OR ITEM OWE
WATER CLOSET MAIL
SATE TOB ADDRESS
SHOWER CITY TSL N
CONTRACTOR
LAVATORY
SIISS ADDRESS ,/
DISHWASHER CITY /"'-[A Z Q
CONTRA
LRUNDRY TOB UGIATIORNSNO tl covprlr
CLOTHES WASHER DISTRI NO GROUP NE P SED BY
WATER HEATER
GAS SYSTEM INDUSTRIAL i
WASTE APPROVAL >.
INSPECTION RECORD O
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® it DOPER ITEM
OR P18T0 APPROVALS DATE INSPECTOR S SIGNATURE
PERMIT S 2 00 UNDER SLAB WORK
TOTAL FEE ROUGH PLUMBING
GAS PIPING
1 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
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I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED A OR PLUMBING FIXTURES I I
LICENSED A8 REQUIRED BY L08 ANGELES COU AND S OR GAS TEST
CALIFORNIA OR THAT I AM THE LBGAL OF T OVB
DESCRIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED I I
SIGNATURE II�,�-f I
OF PERMITTE y pY!FINAL R l 1/3, 1/fl/V"/--
CKVALIDATION ROBERT AI WOOD
M O CASH SUPERVISING MECHANICAL ENG R
Li.o 9 0 6 1 IAP, 2 5 D 3 00
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