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76A607-CE817 10-60
APPLICATION- FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDINCAND SAFETY DIVISION FADD
7-
JOHN A. MBIE, COUNTY ENGINEER
17
WILLIAM A. JENSEN, SUPT OF BUILDING.
FOR APPLICANT TO FILL IN NEAREST
NUMBER FIXTURE OR ITEM '
WATER CLOSET , D
BATH TUB
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LAUNDRY TUB REGRI�TRATTION NO. B C/ COUNTY
CLOTHES WASHER DISTRICT NOGROUP ZONE OCES D 8
WATER HEATER Z
GAS SYSTEM INDUS
WASTE APPROVAL / y,
/INSPECTION RECORD O
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APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT 51 2 LOO UNDER SLAB WORK
TOTAL FEE �v ROUGH PLUMBING
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 THE.
AND STATE LAWS REGULATING
PLUMBING. HOT WATER HEATER
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST I J
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE. ABOVE .
DESCRIBED RESIDENTIAL PROPERTY. 2 UTILITY CO.NOTIFIED
SIGNATURE• �' ell
OF PERMITTE /'/'//V
FINAL 1
VALIDATION ROBERT A . qbD _
M.o. CASH SUPERVISING MECHANICAL ENG'R
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