HomeMy Public PortalAbout5022 FARAGO AVE_Plumbing__ 76A8O7 CE817 10 60
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUIL AG AND SAFETY Doff FNEAMST
7-
FOR
JOHN A LAMBIE COUNTY ENGINEER 5022- a 1-a O
WILLIAM A JENSEN SUP T OF BUILDING PLH f `
APPLICANT TO FILL IN S ST
NUMBER FIXTURE OR ITEM OWNER
2 WATER CLOSET z 5 N,
BATH Tub
ADDRESS
j / 2 S
SHOWER CITY TEL NO
Z, LAVATORYCONTRACTOR
2 so
1 Bnm ! 2 s- ADDRESS 1-1/L17 Al /lpl-c eel /7ve
DRiHWASHER crn d !Ll rn NO Xp ATE
W616
STATE
LAUNDRY TOB
CONTRACTOR
NO /2 7 a S �o COUNNTY
CLOTHES WASHER 125- DISTRICT NO1.GROUP ZONE PR SSED BY
WATER HEATER O
GAS SYSTEM / S INDUSTRIAL
WASTE APPROVAL
I INSPECTION RECORD O
/'`9. ,29 o
z
S OtFPER ITEM
$ I 75 ,
APPROVALS DATE INSPECTOR S SIGNATURE
PERMIT $ 2100 UNDER SLAB WORK
TOTAL FEE /3 �— ROUGH PLUMBING
✓ GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH BALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMING HOT WATER HEATER A �FLr
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED A9 REQUIRED BY L09 ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE L 1
DESCRIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED
SIGNATURE
OF PERMITTEIr ��A✓�
FINAL
VALIDATION ROBERT A WOOD
CK M o CASH SUPERVISING MECHANICAL ENG R ti
LAC01 9 2 7- JUL 2 0 5 D 1375-
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