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APPLICATION FOR PLUMBING PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS D .
JOHN A. LAM.BI.E. COUNTY ENGINEER
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST.
CROSS ST.
NUMBER FIXTURE OR ITEM
OWNER
WATER CLOSET
BATH TUB ADDRESS
SHOWER 'CITY .NO.
'LAVATORY CONTRACTOR
SINK ADDRESS �' •y .
DISHWASHER CITY. CAO
TEL:NO y /.%t�
LAUNDRY TUB CONTRACTOR'S � �,, ��r-�y STATE
REGISTRATION.NO. K d COUNTY
CLOTHES WASHER
DIST O.. ROUP Z NE READY FOR INSPECTION
WATER HEATER e. DD A•�
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
I INSPECTION RECORD
APPROVALS
$1.00 PER ITEMDATE INSPECTOR'S SIGNATURE
OR FIXTURE $ BQ UNDER SLAB WORK
LLL
PERMIT $ 1100 ROUGH PLUMBING' r
.
GAS PIPING
TOTAL FEE 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 AL'L COUNTY ORDINANCES AND STATE LAWS .REGULATING PLUMBING FIXTURES
PLUMBING.• ..
1 I,iEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS.TEST
LICIIVSE. AS REQUIRED BY LOS ANGELES COUNTY AND ST TE OF
CALIF01INIA OR THAT I Alp THE LEGAL OMINER F H V5 UTILITY CO. NOTIFIED
DESCRIED gESIDENTtA PRORl'Y.
SI' RE I r FINAL �� 1✓
OFF PER PERM ITTE
0s• yye� ROBERT A. WOOD,
IDATION SUPERVISING MECHANICAL ENG'R
.CK. M+0. ,+ CASH
r AIN-
23683R JUN 30 5 A 2.00 N