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FBA667-CE#817 5-81'
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENG21M
B AcoE� ON RE�HNA. LAME. ENGINEER ADDR AAI I Na R 45-A if
WILLIAM A. JENSEN, SUPT OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN �ST,
NUMBER FIXTUREOR ITEM
OWNER Gib c� 6. Govs D
WATER CLOSETL
BATH TOS ADDRESS 9 o fCP R fFk c/fic 1R ffA l
SHOWER CITY T A Mr P C iT'/ TEL NO. , /
LAVATORY CONTRACTOR O NJ/V ER
ADDRESS
SDOC
DISHWASHER CITY TEL NO.
TRALAUNDRY TOB E G TRILTION NO. COUNTOTY
CLOTHES WASHER DISTRICT NO GROUP ZON� PRO D BY
WATER HEATER
GAS SomaS INDUSTRIAL O
WASTE APPROVAL V
INSPECTION RECORD 0
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W
O.
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Von
ITEM
IDBS $ APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
TOTAL FEE 3 (:) ROUGH PLUMBING
GAS PIPING
I
HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIN APPLICATION "
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL dOUHTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. HOT WATER HEATER
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS•ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF E ABOVE -
DESCRIBED RESIDEN:=ZRTY. UTILITY CO.NOTIFIED
SIGNATURE
OF PERMITTE FINALto
ALMATION ROBERT A.WOOD J
M.0. CASH SUPERVISING MECHANICAL ENG'R ll
p4 63.2% M22 5 0 350- 0