HomeMy Public PortalAbout5413 CLOVERLY AVE_Plumbing__ 76A667-CE817 12/59 I
APPLICATION FOR PLUMBIN PERMIT �
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND ES FETY MSION ADDRESS
JOHN A LAMBI OUNTY NGINEER
WILLIAM A JENSEN SUPT OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM
OWNER
WATER CLOSET MAIL
l
BATH TUB ADDRESS
CITY TEL NO
SHOWER
LAVATORY CONTRACTOR d
SINK ADDRESS /
DISHWASHER CITY - TEL NO VICOUNTY
CONTRACTOR S LAUNDRY TUB REGISTRATIONNO O 2 b
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CLOTHES WASHER DISTRICT NOQ/ GROUP ZONE P OCE Y
f WATER HEATER D V
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
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$1 00 PER ITEM
OR FIXTURE $ APPROVALS DATEI, IINSPEgTy9RR S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK ' I [
TOTAL FEE
ROUGH PLUMBING
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GAS PIPING , 0
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT /} qI�✓t`/�
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AHD/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST .AI, = ^v
DESCRIBED
CALIFORNIA
RESIDENTi L ROPERE LEGAL OWNER OF THE ABOVE UTILITY CO NOTIFIED
SIGNATURE f
OF PERMITTE FINAL 222
Or ALIDATION ROBERT A WOOD,
oc.
x 0 CASH SUPERVISING MECHANICAL ENG R
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