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APPLICATION FOR PLUMBING PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION sU1LDiPiG
JOHN A. LAMBIE, CountF En�inees ADDRESS 8a ICL Ctw�
CASSATT D.GSIFPII�i,sup).of wilding LOCALITY
FOR APPLICANT TO FILL IN NRAMT_ ����
NUMBER FIXTURE OR ITEM CROSS OWNER
WATER CLOSET
MAIL. 'fin:
RATH TOB ADDRESS c C/'
r SHOWER CITY u ( TEIa NO. AT G^7�'1'I
LAVATORY CONTRACTOR `
r anus ADDRESS / G
DISHWA$IZER Gr rtirl.Z+-�-s.� TEL.NO. 80�'/I�'/
LAUNDRY TOB CONTRACTOR'S /!��-3 STATE ❑
REGISTRATION NO. COIINTY
f CLOTHES WASHER D18TRICT NO. GROUP ZONE P CESSED BY
J WATER HEATER
GAS SYSTEM DMUSTHIAL
WASTE APPROVAL
SPECTION RECORD
APPROVALS
@- $1.00 PER ITEM
SAM $ I f0,b0 " DATE INSPECTOR'S SIGNATURE'
UNDERT9swORK
PERMIT $ 2 00 ROUGH PLUMBING
TOTAL FEE /,Z p p GAS PIPING
! 'HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER
WITH ALL .COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. PLUMBING FIXTURES ASI
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/ORGAS TEST / 71 0/
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND 'STATE OF'
' CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVEUTILITY'CO.NOTIFIED
DESCRIBED RESIDENTIAL PROPERTY. f
SIGNATURE FINAL
OF PERMITTEE
ROBERT A.WOOD.
OF ALIDATION SUPERVISING MECHANICAL ENG'R'
CK. M.0. GASB
4CO 6 6 2 5 n OCT 2 8 5 A .1 2.0 0 M