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APPLICATIOW FOR PLUMBING PERMIT �
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDINC�AND SAFETY DIVISION BUILDIN
JOHN A. MBIE. COUNTY ENGINEER ADDRESS
WILLIAM A.JENSEN,SUPT OF BUILDING
LOCALiTYC
FOR APPLICANT TO FILL IN NEST
CROSS ST.
NUMBER FIXTURE OR ITEM
OWNER.
WATER CLOSET
RATE TUB ADDRESS
CITY
TEL NO.
SHOWER
CONTRAC
LAVATORY
SIITB ADDRESS8
DffiHINASHEH CITY TEL.
/ NO.
LAUNDRY TUB REGISTRATION NOCOUNTY
CLOTBES WASHER DISTRICT NO. NE ED BY
WATER HEATER
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
O
V
W-
OS FixTIJRB $ I
APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ E 00 UNDER SLAB WORK 4
TOTAL FEE ROUGH PLUMBING
i
GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ ANIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
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 A E LEGAL OWN OF THE ABOVE
DESCRIBED RESIDENTIAL P P TY. UTILITY CO.NOTIFIED
SIGNATURE
OF PERMITTE
FINAL
®i• VALTDATI ROBERT A.WOOD.
■.O�
PF
_R
MECHANICAL ENWR
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APPLICATION FOR PLUMBI G PERMIT �
DEPARTOMENT OF COUNTY Fd�TGINEER
BUII.DING AND SAFETY DMSION amLDnaG /
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS L!r
WILLIAM A.JENSEN.SUPT OF BUILCING
LOCALITY ;PC)',& 4 4e Cc�T
FOR APPLICANT TO FILL IN CENEA$$T.
NUMBER FIXTURE OR ITEM e
WATER CLOSET OWNER Ar
BATE TUB AADDDRESS / �`' li Fi v
mm P� c. TEL NO.
SHOWER
LAVATORY CONTRACTOR �'SJAI,' If
Sem ADDRESS
DISHWASHER CITY We S r `o V TEL NO. -S/ L z,
CONTRACTOR'S " STATE
LAUNDRY Toa REGISTRATION'tfO. /3f7 3 Comm
CLOTHES WASHER DISTRICT NO. GROUP I ZONE P ED BY
WATER HEATER A 17t Al
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
OR $ I 1
APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ E 00 UNDER SLAB WORK
TOTAL FEE r /� ROUGH PLUMBING
�C•' GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. HOT WATER HEATER
1 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 T�IAMHE LEGAL OW ER OF THE ABOVE
DESCRIBED RESIDERTY. UTILITY CO.NOTIFIED
SIGNATURE
OF PERM' FINAL
Dr VAMATIO OBERT A.WOOD,
cz, M.O, �g UPERV181NG MECHANICAL ENG'R
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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS .ANGELES
DEPARTUMT OF COUNTY ENGINEER
BJIILDII�iG D�,SAFETY RI %I N BUDDING
OHN A. Bl COUNTY NGINEER ADORES -
WILLIAM A..JENSEN,SUPT OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM OWNER
WATER CLOSET
nlrnzr.
(� TUB RATADDRESS 4'
Ii
CITY . . TEL:NO.
SHOWER
LAVATORY CONTEACTOR
SIIdB ADDRESS
DR3FiWASHER CITY TEL. NO.
CONTRACTOWSj 5 / STATE ❑
LAUNDRY TUB REGISTRATION NO. I. (P COUNTY
I CLOTHES WASM DISTRICT N �$ P ZONE PROCESSED BY'
WATER HEATER t D ' 1,4'�1..
GAS.SYSTEM INDUSTRIAL
WASTE APPROVAL
-
INSPECTION.RECORD
v
IF $1.00 PER ITEM I a'd 1/10 tj srIL.,
((( OR FDITURE $' .APPRO DATE INSPECTOR'S.SIGNATURV
PERMIT S 2. '00 UNDER SLAB WORK /.r
TOTAL FEE-H
Lo o o ROUGH.PLUMBING I
GAS PIPING R
1 HEREBY-ACKNOWLEDGE THAT 1'HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
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 OWNER OF THE ABOVE d
DESCRIBED RESIDENTIAL P RTY. �. UTILITY CO.NOTIFIED
SIGNATURE
OF PERMITTVFINAL
�a —w AIMATION ROBERT A.WOOD.
M.0. eg= SUPERVISING MECHANICAL ENG'R
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