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APPLICATION FOR PLUMBING PERMIT 1 '
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGIIIM
BUILDING AND SAFETY DIVISION BUILDING Zp
101Di A LAMBIE, CeuntT Eaolew
TT D OHffFDi. SRP 1 d dldNeG LO
FOR APPLICANT TO FILL IN NEAREST
CROSSIST
NUMBER FIXTURE OR ITEM
OWNLI S
WATER CLOYrQUL
_
RATH TUB ADDRESS
SHOWER TF1. NO
LAVATORY CONTRACTOR
Holt ADDRESS
DISHWASHER CRYno
LAUNDRY TUB CO
HEOD3TBA7fON n0 I
CLOTHES WASHER DISTRI O I GB=P— THH RRADY MR SPRCTIGN
` WATER HEATER .lam r — I DI
OAS SYSTEM INDUSTRw'
WASTE APPROVAL
fiWEdff0-N BECORD
I
APPROVALS
91 DOS i (J Od DATE INSPECTOR 9910NATURE
O
6 UNDER BLAB WORK
PERMIT f 00 ROUGH PLUMBING
TOTALFEE O GAB PIPING
I HERMIT ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAB VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER 1
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING PLUMBING FIXTURES L
i
HEREBY
CERTIFY THAT i AM PROPERLY RI 11) AND/OR GAS TEST /
LICENSED AS REQUIRED BY L09 ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO NOTIFIED
DESCRIBED RESIDENTIAL PROPERTY —
SIGNATURE A /�/{J�'
OF PERM ITTEH 1- g
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VAMA7i0 UPERIING MECHANICAL ENO R
ec e o use
11,CO7 9 7 v DEC 16 5 A 1 0.0 0 m