HomeMy Public PortalAbout5422 BALDWIN AVE_Plumbing__ ` \.
76A667-CEBi3 3-59 �
APPLICA°TI®N FOR LLUMBIN PERMI'`T, �
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER °
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS
CASSATT D. GRIFFIN, Sup't of Building
LOCALITY
FOR APPLICANT TO FILL IN Noss TT. �!
• NUMBER FIXTURE OR ITEM.
OWNER t,
WATER CLOSET MAIL
L.� �, fl
BATH TUB ADDRESS
SHOWER CITY'7F f (9ti TEL. NO.
LAVATORY CONTRACTOR
SINS • ADDRESS
DISHWASHER
CITY 7e-NSIel.. e6 TEL. NO. 63/ cs
CONTRACTOR'S STATE
'LAUNDRY TUB REGISTRATION NO. COUNTY
CLOTHES WASHER DISTRIC `NO. GROUP ZONE PR Y
s
WATER HEATER
GAS SYSTEM INDUSTRIAL
® .. WASTE APPROVAL
INSPECTION RECORD
G
$1.00 PER ITEM
/ OR FIXTURE $ pJ o APPROVALS DATE INSPECTOR'S SIGNATURE
•� PERMIT $ 2 00 j, UNDER SLAB WORK
.. ~ 1 �� & ROUGH PLUMBING
TOTAL FEE
PIPING v
I HERFjY ACKNOWLEDGE THAT 1 WVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING "
PLUIIIBING. HOT WATER HEATER
I HEREBY CERTIFY THAT I 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 WNER OF THE ABOVE .
DESCRIBED RESIDENTIAL OPERi UTILITY CO. NOTIFIED
SIGNATURE
OF PERMITTE Fr�C
c FINAL
®�. ALIDATION ROBERT A.WOOD,
CK. M.O. CASH SUPERVISING MECHANICAL ENG'R