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76A667 CE817 12/59
APPLICATIO FOR PLUM NG PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING {��u7���a�� Sr FETY DIVISION BUILDING
JOHN A LAMBIE C OUNTY ENGINEER ADDRESS �� a ��
WILLIAM A JENSEN SUP T OF BUILDING
LOCALITY C �
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM
OWNER
WATER CLOSET MAIL
BATH TUB ADDRESS
CITY TEL NO
SHOWER /
LAVATORY CONTRACTOR , 6
SINS ADDRESS
DISHWASHER CITY �V O /1�/'D(Il rc� TEL NO gzl Q1E]CONTRACTOR S STATE
LAUNDRY TUB REGISTRATION NO :3,6 !/T COUNTY
CLOTHES WASHER DISTTRjI TNO GROUP Z NE JVKCESSEDBY
WATER HEATER J r D
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
P.
0
/ 84,g~ G 0
F
—9--
5100 PER ITEM
OR rDITURE $ �� d�u APPROVALS DATE , INSPECTOR S SIGNATURE
PERMIT $ 2.100 UNDER-991 WORK-H
TOTAL FEE
ROUGH PLUMBING d
Qui
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 L COUNTY OR AND STATE LAWS REGULATINGPLUMHOT WATER HEATER ,, !
I HEREBY CERTIFY THAT I 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 PROPER UTILITY CO NOTIFIED
SIGNATURE
OF PERMITTE l
ro FINAL
OF VALIDATION ROBERT A WOOD
ctc B 0 CASH SUPERVISING MECHANICAL ENG R
Lro 5 2:0 SIP 1 5 D 13 0 0 ,�