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APPLICATION FOR PLUMBING PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BRH.DIxG
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CISRSATL D GRIFFIN SuP t of 8ml�v LOCALITY �M
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM
/ WATER CLOSEL OWNER iP Vve/I�itG.✓
BATH TUB RESS S
ADD .2- /2e. Z/!l.v O/ / ✓G
/ SHOWER CRY Tf.✓ /G -,E y TEL NO
/ LAVATORY CONTRACTOR,,/a,4, ✓. C O o et ��66
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DISHWASHER CITY TEL NOI
LAUNDRY TUB CONTRACTORS SLATREGISTRATION NO /.SO-SOD -( .d(R COUNEl
CLOTHES WASHER _ DISTRICT NO GROUP Z NE READY FOR IN5IECTIOM
WATER HEATER
GAS SYSTEM ♦ •INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
APPROVALS
31 DO PER ITEM IDATE INSPECTOR'S S NATURE
OR FIXTURE a UNDER SLAB WORK
PERMIT 00 ROUGH PLUMBING /
TOTAL FEE GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TD COMPLY HOT WATER HEATER
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING PLUMBING FIXTURES A
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST'
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO NOTIFIED
DESCRIBED RESIDENTIAL ROPERTY
SIGNATURE
OFPERMITTEV FINAL
ROBERTA'WOOD v"
®Y VALIDATION SUPERVISING MECHANICAL ENG R '
C6 Y D CASH
[402 0 1 5 S JAN 21 5 A 6.0 0