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76A667-CE817 12/59 �Q
APPLICATION F LUML rING PERMIT
COUNTY OF LOS ANGELES /
DEPARTMENT OF COUNTY ENGINEER q /� c�j
BUILDING AND SAFETY DIVISION BUILDING ��tr' G�%-1/lam/T �J
JOHN A. LAM BIE, COUNTY ENGINEER ADDRESS
WILLIAM A. JENSEN. SUPT OF BUILDING
' LOCALITY
FOR APPLICANT TO FILL IN NEAREST lr C
CROSS ST. / !✓ J
NUMBER FIXTURE OR ITEM OWNER ��
42AV/Z2
0, WATER CLOSET IL ,//
ADDRESS !�
BATH TUB
CITY
SHOWER r
CONTRACTOR ol-lv
LAVATORY /�r
SINS ADDRESS,3 � `h'� 4r4
DISHWASHER CITY � �/ � O. / ���;3�i'
CONTRACTOR'S STATE
LAUNDRY TUB REGISTRATION NO. COUNTY ❑
��.► CLOTHES WASHER DISTRICT NO. GROUP-� I V NE P OCESSED BY
WATER HEATER UQ
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
a
0
F
z
I @ $1.00 PER ITEM
OR FIXTURE $ 7/ �U APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ /2100 UNDER SLAB WORK ..
TOTAL FEE ROUGH PLUMBING
.s GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 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
PLUMBING. HOT 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 1 AM THE LEGAL OWNER OF THE ABOVE -
DESCRIBED RESIDENTIAL PPRROPERTY. UTILITY CO.NOTIFIED
SIGNATURE �jj �'!'.✓�_
OF PERMITTEE
FINAL
®� VALIDATION ROBERT A. WOOD.
cr. M.0. CASH SUPERVISING MECHANICAL ENG'R
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