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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A LAMBIE, COUNTY ENGINEER ADDRESS 10� 2 E V R=Pst
WILLIAM A JENSEN SUP T OF BUILDING LOCALITY
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FOR APPLICANT TO FILL IN NEAREST
CROSS ST P e• P
NUMBER FIXTURE OR ITEM EACH FEE
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WATER CLOSET $125 OWNER S. SZaba
MAIL
BATH TUB 1 25 ADDRESS Same
SHOWER 125 CITY A mp TEL NO.
GT 3 2653
LAVATORY 125 CONTRACTOR
SINN 125 ADDRESS
10920 E Grand
DISHWASHER 125 CITY ; V TEL NO.443 6905
CONTRACTOR'S STATE
LAUNDRY TUB 125 REGISTRATION NO 211898 COUNTY ❑
CLOTHES WASHER 125 DISTRICT GROUPZ NE P ESSED BY
WATER HEATER fin l aoso 50
GAS SYSTEM t L I-50 INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD
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' APPROVALS DATE INSPECTOR S SIGNATURE
PERMIT $ 2 O0 UNDER SLAB WORK
ROUGH PLUMBING J /
TOTAL FEE0 GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
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L COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATERY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
IA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO
THE ABOVE DESCRIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIEDREMITTEE
FINAL
/VALIDATION ROBERT A WOOD
CK M D CASH SUPERVISING MECHANICAL ENG R
L�Ato 1 9 0 10FEB 2 6 5 C 3.5 0 �s