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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BNIAGLMECFEyEGNORSSSouNTY NEEADDRESS y Q
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WILLIAM A JENSEN SUP T OF BUILDING
LOCALITY
FOR APPLICANT TO FELL IN NEARESTT
FNUMBER FIXTURE OR ITEM OWNER ,(I
WATER CLOSET S
KRIL
BATH TOB ADDRESS 7 3 Y
SHOWER CzrY / TEL NO 41-G 6 qa
Z LAVATORY CONTRACTOR
SINK ADDRESS
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DISHWASHER CIlY �.rr� TEL NO -+d 7 3 7 Q Z
LAUNDRY TOB REGB3TBATION No C-3 6' 1 :33 /O COUP 91
t CLOTHES WASHER DISTRICT ? P ZONE R E BY
J WATER HEATER �o �'r
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
REPECTION43ECORD f A I D-
OR S PEIICTRIJ�
$ / o 6 APPROVALS �D�ATE INSPECTOR S�SIGNATURE
PERMIT $ 2 QQ UNDER SLAB WORK 3 /14p2-
TOTAL FEE i OU ROUGH PLUMBING 0 � _
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1
HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS PIPING
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 II n
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES 1646f-
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE GAS TEST
DESCRIBED RESIDENTIAL Op"
r UTILITY CO NOTIFIED yip
SIGNATURE
OF PERMITTE
FINAL
ALIDATION ROBERT A7 WOOD
G-K-
7
M o ' CASH SUPERVISING MECHANICAL ENG R
,- LP o 9 1 2 $ " MAR 5 5 0 12 00 [+1 r
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