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APPLICATION FOR./PLUMg 1N�C; PE M,IT ,
COUNTY OF LOS ANGELES /OFA 3O "
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION 'AD7DBEI ADRG
JOHN A. LAMBIE. COUNTY ENGINEER ESS /I
WILLIAM A. JENSEN,:SUPi oP BuLLDING-, LOCALITY
?FOR APPLICANT TO FILL. IN- NEAREST -
CROSSST.
NUMBER" FIXTURE OR ITEM OWNER
WATER CLOSET - MAIL
BATH TUB ADDRESS
CITY TEL. NO.
SHOWER
LAV74TORY - - CONTRACTOR :u,y
SINE ADDRESS L Q
DISHWASHER CI .E..I.�...TEL. .N jP'/S'S SI
_
CONMCTOTV .- STATE
LAUNDRY TUB REGISTRATION'NO. COUNTY ❑
CLOTHES WASHER 'DIS RII"S rZONE .I PR c 8Y
N
_b
ATER HEATER'-^ Vin'
GAS SYs^fEM IN�
'1`NSPECTION.RECORD
-w
® $1.00 PER ITEM;' I •,.,
`+ OR FIXTURE APPROVALS PATE INSPECTOR'S SIGNATURE Y!
PERMIT $ 2100 UNDER SLAB WORK
��. ROUGH PLUMBING
TOTAb.FEE •-�Q71 G �
1I HENOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS'PIPING 0 "�•
AND'STATE", HAT,THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT /.$` A +.`•�
WITH J'AGl
PLUM •COUNTY ORDINANCES 'AND STATE -LAWS REGULATING HOT WATER HEATE�
BINGyy!
I HEH£BYri'•GERQUI THAT 1 AM ANGELES
RLY�ISTEREO AND/OR PLUMBING FIXTURES ��/�. R h wwrtrt��+�t 73ayy s.4'� ✓I � . j:
'LICENSED_^AS?REO THAT
BY LOB ANGELES COUNTOWNER iAND E AB OF
VE GAS TEST ' /�I
'DESCRIRNIA(OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE,
+
DESCRIBED-RESIDENTIAL i PROP RTY
HU /�.:' UTILITY CO nNO'TIFIE JI
IGF
eba yn��/
OFJPERMITiEE'' _ FINAL
®F aAr VALIDATION' R ERT A. WOOD.
41
8 PERVISI NG MECHANICAL ENG R C" _
r Uf�o7 7 0.` !� y 5 D .00
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