HomeMy Public PortalAbout9306 BROADWAY_Plumbing__ 76A667-CM17 359
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ADDRESS 1
CAV A. LAMBIE, Co Tty Eng ueer
CASSATT D. GRIFFIN, Sup 1 of Btildivg LOCALI,I,Y
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM
OWNER
WATER CLOSET MAIL
BATH TDB ADDRESS -4 _
CITY 1 1 • TEL NO. Z-
SHOWER
LAVATORY CONTRACTO
SINK ADDRESS-` _ T
DISHWASHER CITY TEL NO.
CONTRACTOR'S STATE [9'
LAUNDRY TUB REGISTRATION NO. L COUNTY ❑
CLOTHES WASHER DISTRICT NO. GR UP ZONE PROCESSED BY
WATER HEATER 11-6 O
GSYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
41-2,40 awl f3CLa c✓'rP
O $1.00 PER ITEM $ / d 0
OR FIXTURE APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2.100 UNDER SLAB WORK
TOTALFEE 3 6-�A HOUGH PLUMBING
U \J GAS PIPING
1 1 HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
I 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 THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. _ UTILITY CO. NOTIFIED
SIGNATURE RESIDENTIAL
PROPERTY.
PERMITTE �_ -�C ,�Liy
FINAL NU
OF VALIDATION ROBERT A. WOOD,
M.o. CASK SUPERVISING MECHANICAL ENG'R
UL8058S MR22 5 A 3.00 VI