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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION am R SS
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
WILLIAM A. JENSEN. SUP'T OF BUILDING T
LOCALITY �/,�
FOR APPLICANT TO FILL IN moss
NUMBER FIXTURE OR ITEM EACH FEE
OWNE TBI��V C .
WATER CLOSET E1.25 /✓[l_ MAIL
HATH TUB 1,25 ADDRESS
SHOWER 1.25 CITY / KAP TEL. NO.
3 LAVATORY 1.25 CONTRACTORAlort Plumhing P, , f .
3 SINK 1,25 7ADDRESS 13933 So . Crenshaw Blvde
DISHWASHER 1.25 CITY Hawthorne TEL. NO. OS 93691❑
LAUNDRY TUB 1.25 STATE
REGISTRATION NO. 193617 C-36 COUNTY ❑
CLOTHES WASHER 135 DISTRIC NO. GRO P E P ESBE AD�BY
WATER HEATER 1.50 -
3 GAS SYSTEM OUTLETS 1.50 � , INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER S PER SYSTEM .20 �� INSPECTION RECORD }
Lli
O
fit 1%7
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2
APPROVALS DATE INSPECTOR'5 SIGNATURE
PERMIT s 2 00 UNDER SLAB WORK 1h
ROUGH PLUMBING , ' n �- � ifza
TOTAL FEE11,
GA$PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APP ILAI GAS VENT 1
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING - HOT WATER HEATER
PLUMBING.
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSE. AS REQUIRE. BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT I AM THE LEG L OWNER OF.AND INTEND TO
RESIDE IN.THE ABOVE....RISE. E pSHTIAL PROPERTY. UTILITY CO. NOTIFIED
SIGNATURE i J
OF PERMITTEE
FINAL
VALIDATION ROBERT A. WOOD
/�..cK. M.O. CASH SUPERVISING MECHANICAL ENG'R
L116,0 4 9 4 3 'A)' 42,0 5 D 2 -0.7 5" -