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APPLICATION FOR PLUMBING PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING Ol
BUILDING AND SAFETY DIVISION ADDRESS (!
JOHN A.LAMBIE, COUNTY ENGINEER
CASSATT D. GRIFFIN., SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM
OWNER
WATER CLOSET
MIL ESSA /
BATH TUB 14
ADDR . 1� �1 s' �x
SHOWER CITY " °f, ��, TEL.NO.
LAVATORY CONTRACeoIj a
SINK ADDRES I;
/ r
DISHWASHER CITY11�� TEL. i0.
LAUNDRY TUB CONTRR GISTMAT OR N0. COUNTY
CLOTHES WASHER
DISTRICT GR ZONE READY FOR INSPECTION
WATER HEATER
1
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION.RECORD
r
S/)7- 4 I SO
I A 4 A r it-A,'a'F-P
APPROVALS
$1.00 PER ITEM DATE INSPECTOR'S SIGNATURE
OR FIXTURE $ / �� UNDER SLAB WORK
ROUGH PLUMBING
PERMIT S 1 00 -
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 CERT4THATM P PERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQGELES COUNTY AND STATE OFI�LITY CO. NOTIFIEDCALIFORNIA OR TLEGAL O.W ER OF TH ABOVE yDESCRIBED RESIDETY. [maySIGNATURE � �t ✓ "�/ FINAL y�G'�a`,p ko e 11
OF PERMITTEE
VROBERT A. WOOD,
ALIDA
SUPERVISING MECHANICAL ENG'R
CK. M. CASH
�t MD 4 4. 53L-mo SEP 4 5 A 2.0 0 W)
JJ V