HomeMy Public PortalAbout10867 GRAND AVE_Plumbing__ 76A667-CE817 6-60 �"- WING
APPLICATION FOR PLUM PERM
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING /
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS ✓�
WILLIAM A. JENSEN. SUPT OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
NUMBER
L +�
NUMBER FIXTURE OR ITEM CROSS '� Q
OWNER
WATER CLOSET MAIL
BATH TUB ADDRESS
sxowER CITY TEL. NO.
LAVATORY CONTRACTOR
SINE ADDRESS
DISHWASHER CITY1-10 (f "v TEL. NO.1,'jo �p
CONTRACTOR'S STATE
LAUNDRY TUB REGISTRATION NO. COUNTY
CLOTHES WASHER DISTRICT N GRO P Z N P O D B
WATER HEATER 1 �,> �
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
N
a
U
L1 D O
r� F
N
Ul
'f
0 $1.00 PER ITEM "
OR FIXTURE $ 41 • T1.
1. APPROVALS 9�AT4 INSPECTOR'S SIGNATURE
PERMIT $ -72 00 UNDER-SLAB WORK /
TOTAL FEE / ' ,f ROUGH PLUMBING
n v 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 HOT WATER HEATER
L
CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
S REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
OR THAT I AM THE LEGAL OWNER OF 7 ABOVE
RESIDEN L OPERTY. 1 / UTILITY CO. NOTIFIED
E ITTE FINAL
®� VALIDATION ROBERT A. WOOD,
CC. Y.0. CASH SUPERVISING MECHANICAL ENG'R