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APPLICATION FOR PLUMBING PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY 1
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM
OWNER
WATER CLOSET
BATH TUB ADDRES
SHOWER CITY TEL.NO. ,
LAVATORY CONT TOR �{
SINS ADDRESS '
DISHWASHER CIT JJ r TEL.NO.lZ" (�' �5
LAUNDRY TUB CONTE. O STATE
REGIS TION N COUNTY ❑
CLOTHES WASHER
DIST NO. GROUP ZONE READY FOR INSPECTION
WATER HEATER ..�./
S
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
�9 E <cAir
APPROVALS
@ $1.00 PER ITEM DATE INSPECTOR'S SIGNATURE
OR FIXTURE $ [ UNDER SLAB WORK
ROUGH PLUMBING
PERMIT S 1100
- � GAS PIPING
TOTAL FEE GAS VENT
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES
PLUMBING.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT AM T LEGAL OWNER OF T E ABOV UTILITY CO. NOTIFIED
DESCRIBED RESIDENTI PROP TY.
SIGNATURE (';L58l !'/
OF PERMITTE FINAL IO . I A.Jv •'
®5 ROBERT A. WOOD,
VALIDATION SUPERVISING MECHANICAL ENG'R
CK. M.0. CA
LAGo 3 9 2 8 0R AUG 18 5A 2.0.0 ig