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APPLICATION FOR PLUMBING PERMIT 1COUNTYOFLOSANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDINGADDRESS
JOHN A. LAMBIE. COUNTY ENGINEER TCASSATTD. GRIFFIN, SUPT OF BUILDING LOCALITY c ,[t (fl
FOR APPLICANT TO FILL IN NEARESTCROSSST.
NUMBER FIXTURE OR ITEM
OWNER 5NU 5
WATER CLOSET MAIL
J BATH TUB ADDRESS d CEN
SHOWER CITY TEL. NO.
LAVATORY CONTRACTO
SINK ADDRESS / Hyl C /,"J //
DISHWASHER CITY ,O TEL.NOCJ,. ^63
LAUNDRY TUB CONTRACTOR'S STATE
REGISTRATION NO. 6 3 —
CLOTHESCLOTHES WASHER
DISTRICT NO. GROUP ZONE READY EOR INS FECTION
WATER HEATER
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL INSPECTION RECORD
T
70
Y
r; APPROVALS
F QY DATE INSPECTOR'S SIGNATUR
ORFIXTURE 4=
7PEA
ITEM
UNDER-=:;P-WORK V1ORFSOU
PERMIT s 1100
ROUGH PLUMBING
Y
GAS PIPING
TOTAL FEE A-/ GAB VENT
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION HOT WATER HEATER
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
IWITHALLCOUNTYORDINANCESANDSTATELAWSREGULATINGPLUMBINGFIXTURES ( 5 -,L1
PLUMBING.
I HEREBY CERTIFY THAT I AM REGI ERED AND/OR GAS TEST
LICENSED A flEOU Y L GELE COUNTY AND STATE OF
CALIFORNI OR AT 1 LEG OWNE OF THE ABOV UTILITY CO. NOTIFIED
DESCftIeED ID TlA1 P TY
SIGNATURE Y a,, FINALOFPERMITTEE
ROBERT A. WOOD.
T),VALIDATION SUPERVISING MECHANICAL ENG'R
CK M.O. CASN
LAw3 5 1 2 m AUG 4. 5 A 11 .0 0 r