HomeMy Public PortalAbout9715 BROADWAY_Plumbing__ 7eA6e9APPLICATION FOR PLUMBING PERMIT �.
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DIVISION OF BUILDING AND SAFETY
to Department of County Engineer
County of Los Angeles BUILDING /J Gh/;��/�� �G�,"k'
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WM.J. FOX. COUNTY ENGINEER ADDRESS %7iJ
CASSATT D. GRIFFIN, SUPT OF BUILDING
LOCALITY It
FOR APPLICANT TO FILL IN NEAREST
^/1 CROSS ST.
OWNER 1- /Aa,-/� DISTR�CT[JO. I GROUP 1'.12'E.1 READY FOR INSPECTION
MAIL H�.r.�
_ADDRESS r p
CITY TEL. NO.A r � WASTER PROVAL
I
PLUMBER ) INSPECTION RECORD
ADDRESS ��mpd
CITY N/I.UWlJLMJ V'xj— TEL.NOZtr
LICENSE NO. I I J`5-,38
NUMBERI TYPE OF FIXTURE OR ITEM FEE1`�T
I WATER CLOSET (TOILET) $ C� G'Poss \+�O.J AJ, OA1 In/LLL(
BATH TUBy' Ql��,a \�QC'Jn tiljly
SHOWER
/ LAVATORY (WASH BASIN)
KITCHEN SINK
DISHWASHER I
LAUNDRY TUB OR TRAY
CLOTHES WASHER
TOTAL NO. a �e-e� APPROVALS
GAS SYSTEM OUTLETS 11.00 OQ_. DATE NSPECTOR'S SIGNATURE
I WATER HEATER nr 1.00 J O UNDER SLAB WORK
ROUGH PLUMBING 1 SC'=J /F IA--�-e-•
P.ERNIT 5 1 00 GAS PI PING IIIu� \3 �(n (1
TOTAL FEE I OO GAS VENT
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION HOT WATER HEATER
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES A
PLUMBING. LL
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST Z 5L _n
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OP. THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO. NOTIFIED N I
DESCRIBED RESIDENTIAL PROPERTY D
SIGNATURE I/`I /� I �if. .(I"'A.�
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OFPERMITTEE dY lY ✓✓PWWWa-a� 11� FINAL ✓L
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION R.A. WOOD, CHIEF PLBG. INSPECTOR
{LAC01 6 619-T JAN -9 3 9.0 0 m