HomeMy Public PortalAbout4840 GOLDEN WEST AVE_Plumbing__ 76A667-CE817 3-59
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS 'jjG���/ ��✓/Q/PrJ /� SCS
JOHN A. LAMBIE, Count Engineer
CASSATT D. GRIFFIN, Supt of Building
LOCALITY
FOR APPLICANT TO FILL IN CROSSSST. 4955�,4 0.e-
NUMBER
yNUMBER FIXTURE OR ITEM OWNER --y--�
J WATER CLOSET L MAIL / C J e,-7
01
BATH TUBADDRESS
CITY TEL. NO.
SHOWER
LAVATORY CONTRACTOR
SINK y ADDRESS 13933 S. Crenshaw 1VC1
DISHWASHER CITY Hawthorne TEL. NO. _
` CONTRACTOR'S STATE
+ ` LAUNDRY TUB REGISTRATION NO. 168479 C-36 COUNTY ❑
/ CLOTHES WASHER DISTRICT NO. GHQJ.W ZONE PR ESSED BY
WATER HEATER 1J
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
$1.00 PER ITEM
/0 OR FIXTURE $ APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2I00kGAS
LAB WORK >�.s'"� /� "' -+ K• _
TOTAL FEE / PLUMBING
ING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLYT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATINGTER HEATER
PLUMBING.
I HEREBY CERTIFY THAT I AM PROPERLY RE TERED AND/ORG FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COU AND STATE OFT
CALIFORNIA OR THAT I AM THE LEGAL OW ER OF THE ABOVE
DESCRIBED RESIDENTIAL OP77T CO.NOTIFIED
SIGNATUREOF PERMITTE
OF YALIDATION ROBERT A. WOOD,
cit. M.o. CASH SUPERVISING MECHANICAL ENG'R