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APPLICATION OR PLU BIND PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AAM131E COUNT DNGINEER BUILDING[NEAREST DRESS 4920 Alessandro Avecp,
WILLIAM A JENSEN SUPT OF BUILDING OCA= Temple City
FOR APPLICANT TO FELL IN
ROSS ST
NUMBER FIXTURE OR ITEM OWNER Warren A] len
WATER CLOSET
DD
ADDRESS 20 Al e ss arld ro Ave.9
sxowER
BATH cn-jT em p l e City TEL No
LAVATORY CONTRACTOR Anthony Pools nc. 9
Sm
ADDRESS it e s •s ,
DISHWASHER CITY south Gate TEL No
CONTRACTOR 3STAT
LAUNDRY TUB REGISTRATIONN;9O179 SC°°' 3 COUNTY
CLOTHES WASHER DIS No OUP ZONE P OCESSED BY
WATER HEATER Q C1Jyy
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
Fresh water piping to 0
swim pool
0
�i
w
a
/ 0 $100 PER ITEM / �,�
OR FIXTURE $ PPROVALS DATE INSPECTOR SS SIGNATURE
PERMIT 2 00 UNDER SLAB WORK •( '.,V
TOTAL FEE ROUGH PLUMBING
GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING HOT WATER HEATER
I HEREBY CERTIFY THAT 1 AM PROPERLY REGI R AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY STATE OF GAS TEST
CALIFORNIA OR THAT I A HE LEGAL OW 7HE ABOVE
DESCRIBED RESIDENT P ERTI-- UTILITY CO NOTIFIED
SIGNATURE
OF PERMITTE /
FINAL
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6A�ATION
CAM SUPERVISING MECHANICAL ENGI R
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