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APPLICATION FOR I�LtJMBING PER'MIT. • 1
Coum .OF LOS.ANGELES: +
DEPARTMENT OF COUNTY ENGINEER :�.',;.:,, .,:':.:;' :• ':. .,.:. .
BUII.DING AND SAFETY DMSIONASSA
BUII:DING
_JOHN A..LAMMB..Couut�Engineer !ADDRESS 73 L f3L U
TT D. GRIFFIN.Sup.t of wilding
_ c LOCALITY
FOR'APPLICANT TC FILL IN NEAREST
:CROSS ST. ig E ST+ .
NUMBER' FIXTURE OR ITEMF
OWNER a
'WATER CLOSET 7 -
.MAIL j
` ADDRESS . 33 j9 h
- . . BATB.TUB -
SHOWER CITY' G E TEL.No.
LAVATORY CONTRACTOR AE
Sig ADDRESS
DISHWASHER CITY TEL. NO.
LAUNDRY TUB CONTRACTOR'S 'STATE ❑:
REGISTRATION'NO.: . .. COUNTY .
CLOTHES WASHER _ DISTRI T NO: 3ONV READY FOA'INSPQC710N
WATER ABATER s
GAS SYSTEM
INDUSTRIAL
WASTE APPROVAL.
INSPECTION RECORD
APPROVALS
/ $1.00 PER ITEM
OR FnmvRE $ I `'OR INSPECTOR'S SIGNATURE
` UN;DER SLAB WORK
PERMIT' S O ROUGH PLUMBING
TOTAL PEE GA's PIPING ��VOW". �::��f, _.d..�•'r�tq . �
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION F GAS VENT
AND 'STATE THAT THE ABOVE IS .CORRECT AND AGREE TO COMPLY �; HOT WATER HEATER
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING :
PLUMBING. K F'L"'UMBI'NG FIXTURE¢
P' 1 .HEREBY CERTIFY THAT i AM PROPERLY.REGISTERED.A'ND/O.R
f LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND. STATE' OF
GAS TEST'
CALIFORNIA OR THAT I AM THE LEGAL OWN"OFTHBOVE UTILITY CO.NOTIFIED
DESCRIBED RESIDENTIAL PROPERTY.
SIGNATURE.
OFPERM'ITTE
N. ROBERTA.WOOD.
OF VALIDATION SUPERVISING MECHANICAL'ENG'R' -
t,4Co 6.2 9 8 , Nov 35 3-.0