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APPLICATION.-FOR. PLUMBING•PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISIONBUILDING
IOHN A.LAMBIE, County Engineer ADDRESS
CASSATT D. GRIFFIN,Sup t of Building -iADDRESS
LOCALITY.
FOR APPLICANT TO FILL IN NEAREST
r. NUMBER FIXTURE OR ITEMCROSS ST. i _ •'L...l
WATER CLOSET OWNERKAM
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BATH TUB
SHOWER CITY NO.
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LAVATORY CONTRACTOR
I
SmX ADDRESS
r DISHWASHER CITY TEL.NO: ( �r
r. LAUNDRY TUB CONT T 8'S �9
REGISTRATION NO. F9IINTY ❑
CLOTHES WASHER DISTRICT NO: GROUP �ONF ,I READY FOR INSPECTION
WATER HEATER e..r
GAS SYSTEM. INDUSTRIAL
WASTE APPROVAL
i INSPECTION RECORD
i
APPROVALS
~' @ $1.00 PER ITEM
- DATE INSPECTOR'S SIGNATURE
OR FIXTURE
UNDER SLAB WORK �
PERMIT $ � 00 ROUGH PLUMBING
t TOTAL FEE " GAS PIPING
E' I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENTA
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
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST p
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ..
CALIFORNIA OR THAT 1 AM THE. LEGA NER OF THE ABOVE UTILITY CO.NOTIFIED
DESCRIBED RESIDENTIA PROPE
'. SIGNATURE
OF PERMITTE a. FINAL ,9
ROBERTA.WOOD.'
OF VALIDATION SUPERVISING MECHANICAL ENG,m
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CK. N.b. CASH �—-�