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APPLICATION FOR PLUM ING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A LAMBIE County En sneer ADDRESS (ty
CASSATT D GRIFFIN Supt of Buildmg LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM
OWNER 14
WATER CLOSET MAIL '
BATH TUB ADDRESS
SHOWER CITY TEL NO
LAVATORY CONTRACTOR DON'S PLUMMING SERVICE
SINK ADDRESS 840 So Bnldwti n ,Avenue
DISHWASHER CITY A-ca jo, Cm. No Hi 7-0882 <
CONTRACTOR S STATE ❑
LAUNDRY TUB REGISTRATION NO COUNTY Cl
CLOTHES WASHER DISTRICT NO GROUP /;ONE F OCESSED BY
WATER HEATER (� j
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
mot
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AV A-7 IvAyllcmg It 141hpoe-
$I DOPER ITEM ' /Cp/�'�a7 f QrJJ S' A?V k heg;� — ,
OR FIXTURE $ , ROV LS D TE INSP CTOR S§KNATURE
PERMIT $ 2 00 UNDER 6 Act3'WORK Z
TOTAL FEE ROUGH PLUMBING 10 '
�V GAS PIPING .� B i.`.(7
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 ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING _
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I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES ZIS
r LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE GAS TEST F1 t0l_ l"4-690
DESCRIBED RESIDENTI PROPERTY UTILITY CO NOTIFIED
SIGNATURE ►�\\
OF PERMITTEE
FINAL
OF v ALMATION ROBERT A WOOD
OK m p cAsa SUPERVISING MECHANICAL EN,G R
1 ? o -D 4 u JL IN ?3 5 D c.,.�. U U r i�
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