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OF® �uMBING PERMTAPPLICATI
COUNTY OF LOS ANGELES
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
Cr
NUMBER FIXTURE OR ITEM OWNER -
�i WATER CLOSET MAM
BATH TUB ADDRESS
CITY TEL NO.
SHOWER
LAVATORY CONTRACTOR Alert P lb o & Htg.
SINK
ADDRESS 13933 S . Crenshaw Blvd .
DISHWASHER CITY Hawthorne TEL. NO.Os o 93691
CONTRACTOR'SSTATE tl
29
LAUNDRY TUB REGISTRATION NO. 1936'7 C X36 COUNTY
CLOTHES WASHER V
O. GROUP ONE P OCESSED BY
WATER HEATER
GAS SYSTEM
VAL
INSPECTION RECORD
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n,t i 0
' MH
00 PER ITEM 4., ZI-I'lleNoi 40_14�1
FIXTURE
AP ROVALS D TE INSPECtOR'SSIGNATURE
PERMIT $ [77�2 PLUMBING /
GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICTION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING. _
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES N '
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE AlOF lel n � ^
CALIFORNIA OR THAT I AM THE LEGAL N$R OF HE ABOVE GAS TEST II� it .7. I +'A'
DESCRIBED RESIDENTIAL PERT / UTILITY CO.NOTIFIED .n i� q,
SIGNATURE J , I /A,/i I'
OF PERMITTEE_ p �y
FINAL
®r ,{VALIDATION ROBERT A.(WOOD,
CK.' ■,O, c"H SUPERVISING MECHANICAL ENG'R
-LAP,)9 8 8 5 -0 jUL 12 5 D 12.0 ❑
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