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IIS' 76A667-CE#817 5.61 --
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS �2 02 �i/ l jywXryr`�
WILLIAM A. JENSEN, SuP'T OF BUILDING �y
LOCALITY {L`/
FOR APPLICANT TO FILL IN NEST
CROSS ST.
NUMBER FIXTURE OR ITEM OWNER
?r-- WATER CLOSET MAIL .
HATH TUB ADDRESS
/ CITY TFL.NO.
SHOWER
CONTRACTOR
LAVATORY
SINK ADDRESS
DISHWASHER CITY TEL. NO.
CONTRACTOR'STA ❑
LAUNDRY TUB REGISTRATION NO. COUNTY o
/ CLOTHES WASHER DISTRICT NO. GROUP ZONE PR SEED BY
WATER HEATER
GAS SYSTEM INDUSTRIAL _V
WASTE APPROVAL
INSPECTION RECORD a:
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W
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@ ER ITEM0frF /
IXTURE $ / i1C,? APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ ! 2 00 UNDER SLAB WORK
TOTAL FEE ROUGH PLUMBING
GAS PIPING
IHEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORFECT 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 RESIDENTIA P P RTY.
[//,' UTILITY CO. NOTIFIED
SIGNATURE OF PERM TTEE '«!� °r
FINAL
LIDATION ROBERT A. WOOD
EK.
M.0. CASH SUPERVISING MECHANICAL ENG'R
DEC 4 5 a i 5.3 0-
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