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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING 1
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS /O w1w- /
WILLIAM A. JENSEN, SUPT OF BUILDING s
LOCALITY � `_ .
FOR APPLICANT TO FILL IN NEST
CROSS ST.
NUMBER FIXTURE OR ITEM OWNER
y. WATER CLOSET ,'2,St7
MAIL
/
ADDRESS
BATH TUB / ;
CITY TEL NO.
SHOWER
Z,.-- LAVATORY CONTRACTOR Valley Plumbing Co.
I SINg 1 ; ADDRESS 442 W. Fleetwood Pl,
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DISHWASHER
CITY Glendora TEL. NO. Ed 5_1
CONTRACTOR'Sr STA ❑
LAUNDRY TUB REGISTRATION N016O84/ COUNTY
/ CLOTHES WASHER 1 j DISTRICT NO. GROUP Z NE P 7SSED BYWATER HEATER � �' t� � f !�; d
GAS SYSTEM INDUSTRIAL 0
WASTE APPROVAL
INSPECTION RECORD 09
0
1-�
U
W
O.
N
Z
ER ITEM
OR FIXTURE $ APPROVALS DATE INSPECTOR'S SIGNATURE
-H PERMIT $ 2100 UNDER St aB WORK
TOTAL FEE s- ROUGH PLUMBING
GAS PIPING
IHEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER ~
PLUMBING.
1 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 PROPERTY. UTILITY CO. NOTIFIED _
SIGNATURE gY�
OF PERMITTEE FINAL `'�':�+� .•? - ,,_9... .�/-
VALIDATION ROBERT A. WOOD
CK. M.0. CASH SUPERVISING MECHANICAL ENG'R
LAW 7 8 2 5c DEC 4 5 D 1 5.30-
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