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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE. County Engineer ADDRESS` (j 0.11 L%kMan
CASSATT D. GRIFFIN, Supt of Building LOCALITY Te rinl e City
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM �
OWNER J• y+� . p-�OTl�>tcld
2 WATER CLOSET MAIL 26 6 Baldwin
1 BATH TUB ADDRESS
1 SHOWER CITY rCc dlc'1. TEL NO.HI 6-4495
2 LAVATORY CONTRACTOR Belvedere i !um.bin . CO.
1 SINS ADDRESS 1-1900 E, Garve` L 1'T-
DISHWASHER CITY El 1'iOnte TEL. NO.GI 8-9836
CONTRACTOR'S �} STATE ❑
LAUNDRY TUB REGISTRATION NO. Z 6O COUNTY ❑
1 CLOTHES WASHER DISTRICT NO. GROUPz0 R ES B
Z WATER HEATER �5o (/
1 GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
;.j
0 $1.00 PER ITEM I °� ® o,Aa tF f..c]4,rig-® iL44,. t-
10
-.-R.10 OR FIXTURE $ 10 00 APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER WORK
TOTAL FEE I12 00 ROUGH PLUMBING
GAS PIPING �
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING. -
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES i
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST >S
CALIFORNIA OR THAT 1 AM THE LEGAL WNER OF THE ABOVE
DESCRIBED RESIDENNjIAAI} PROPERTY. UTILITY CO. NOTIFIED
SIGNATURE 14
OF
-
OF PERMITTEEdg-z,��CC
FINAL
®P ALIDATION ROBERT A. WOOD,
C6. H.O. CASH SUPERVISING MECHANICAL ENG'R