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-APPLICATION FOR -,PLUMBING - PERMIT ,
'COUNTY OF LOS ANGELES
4 DEPARTMENT OF COUNTY. ENGINEER
BUILDING AND, SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
WILLIAM A. JENSEN, SUPT.OF BUILDING - -
LOCALITY
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FOR APPLICANT TO FILL IN NEARESTT. ICROSS S
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NUMBER FIXTURE OR ITEM OWNER
WATER CLOSET /
MAIL
BATH TUB ADDRESS
CITY TEL NO.
SHOWER
LAVATORYCONTRACTOR Valley Plumbing: .
slNg ADDRESS 442 W. Fleetwood
CITY Glendora .DISHWASHER
TEL:NO.
CONTRACTOR'S 8 A�
LAUNDRY TUB REGISTRATION NO. 16Q8$7 COUNTY
` CLOTHES WASHER DISTRICTNO,
C 6R UP ZONE P. SSED
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/ WATER HEATER �F �L•C L� dO
GAS SYSTEM INDUSTRIAL y
WASTE APPROVAL
1. D Jk^), INSPECTION RECORD,
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a $1.00 PER ITEM
OR FIXTURE' $ ' yy APPROVALS DATE INSPECTOR•S'SIGNATURE
PERMIT $ 2 00 ry UNDER SLAB WORK
TOTAL FEE I� ROUGH PLUMBING v ,
GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION r
AND-STATE THAT THE ABOVE''.IS CORRECT-AND AGREE TO COMPLY /' GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS. REGULATING
PLUMBING. HOT WATER HEATER _��
I HEREBY CERTIFY THAT .1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES v<._ ,: c • ��,
LICENSED.A3 REQUIRED'BY LOS ANGELESCOUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE VV
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DESCRIBED RESIDENTIAL PROPERTY, - - UTILITY CO. NOTIFIED , (/ A _. FK-SI N F/
a SIGNATURE /� Y bbl T div:/J
OF PERMITTE r
FINAL
VALIDATION ROBERT A. WOOD
cK.
M.0. CASH SUPERVISING'MECHANICAL ENG'R
Ltt� 6 .1,.3 '1 OCT9 5-p 6 2_5
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