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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING {
JOHN A. LAMBIE, Co— EnV.s ADDREBB d
CASSATT D. GRIFFIN. Sup f of Hwlding LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM
/ OWNEB
WATER CLOSET MAM
RATH TDB DRESS 0 _
SHOWER CITY TEL. NO. j
LAVATORY CONTRACTOR
SING L ADDRESS �- � _['G�fCY
DISHWASHER CITY TEL NO.
CONTRA TOR'S STATE
LAUNDRY TUB REGISTRATION NO. COUNTY
CLOTHES WASHER DISTRICT NO. GROUP ZONE PROCESSED BY
WATER HEATER .S
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
p INSPECTION RECORD
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• OEC P $ �J
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APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT S E 00 UNDER SLAB WORK 3" 0 �'-��~�•
TOTAL FEE ROUGH PLUMBING -'✓3 �0 r A' hA•-I
• GAS PIPING
1 HACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT
AND
STATE STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. HOT WATER HEATER --e
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBEDIAL P 0 ERTY. UTILITY CO.NOTIFIED
SIGNATURE
OF PER ti��e�
FINAL / y�
®F 7AUDATION ROBERT A. WOOD,
SUPERVISING MECHANICAL ENO•R
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