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APPLICATION FOR LU"I G PERMIT
COUNTY OF LOS AN=.EB
DEPARThUM OF COUNTT ENGENM
BU�EOL�DING AND SAFEETT�DI�VI�S.I.eON
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FOE APPLICANT TO FILL IN
NUMBER IwLXTUR$OR ITEM Owm
WATER CLOS w O
EAffi TUE ADDHm S
6HOWIB CIIT TM NO.
LAVATORY COMmACTaE L 120
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DIESWABEER Com! ; TEL. NO.
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CLOSE WABEM2 DISTRICT N agoup ZON$ BY
WATER BEATI3B
GL" aTeT81t DcUE'IBIAE
WASE APPROVAL
APPROVALS
�a°rte 1 O
DATE INSPECTOR'S DIGIfATURH
H2t SLAB WORK
PERMIT $ 2 00 ROUGH PL"SINo
TOTAL FEE owe PIPINCI
I HER ACKNOWLEDGE THAT I RAVE RRAD THIS APPLICATIONFrICMA
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AND STATE TEAT THE ABOVE IS CORRECT AAD AGREE TO COMPLY /ATEl3 HEATER
MICR AIL COUNTY ORAIMNCE3 ARD STATS LAWS REGULATING
PLUMBING. d
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AMVOk
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AN GAL OWNER 0 THE ABOYIco,N
DESCRIBED RESIDENTIAL�PR
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O FERMI
ROBERT A WOOD.
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APPLICAT ON FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER ` �f
BUILDING AND SAFETY DIVISION BUILDING
AU'LDDRESS SS J �-s
JOHN A. A. JEN E, COUNTY ENGINEER
WILLIAM A. JENSEN, SuP'i OF BUILDING —�
- LOCALITY ,� I
FOR APPLICANT TO FILL IN NEAREST T. p�4,t7 I✓
NUMBER FIXTURE OR ITEM
OWNER
WATER CLOSET MAIL
BATH TUB ADDRESS
CITY TEL. NO.
SHOWER
LAVATORY CONTRACTOR
SING ADDRESS O � �
DISHWASHER CITY f5-- TEL. NO.
CONTRACTOR'S STATE ❑
LAUNDRY TUB REGISTRATION NO. COUNTY ❑
CLOTHES WASHER DISTRICT NQ. GOUP ZONE P OCESSED BY
WATER HEATER y
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD >.
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0
U
x
0 e
U
W
a
z
OR FIXTURE ITEM �+
$ APPROVALS DATE INSPECTISIGNATURE
PERMIT $ 2100 UNDER SLAB WORK
TOTAL FEE � ROUGH PLUMBING
CJS GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. HOT WATER HEATER
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST -
CALIFORNIA OR THAT I AM THE LEGAL QWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PRO. aft UTILITY CO.NOTIFIED
SIGNATURE
OF PERMITTE
li-�
FINAL
OF VALIDATION ROBERT A. WOOD,
CC. M.0. CASH SUPERVISING MECHANICAL ENG'R