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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING
HN L AND
SAFETY DIVISION ADD ESS �` °°7
CASSATT D. GRIFFIN,Sup f of Engineer
LOCA �"'
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM
OWNER
WATER CLOSET MAIL
BATH TUB ADDRESS
SHOWER CITY TEL.NO.
LAVATORY CONTRACTOR
sm ADDRESS 13933 So, Crenshaw Blvd.
DISHWASHER Crrr Hawthorne TEL, No- Os 9-3691
CONTRACTORIS
rapmEy TIIB REGISTRATION NO. 168479 Cm36 co1JNTY
CLOTHES WASHES DIS[ NO. GROUP ZO :;FCZSSED BY
J WATER HEATER .•_'-67
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
a
t �'�rss � �zs l r•� ~
7L,,-
0
vP
OBFDPER r=
MURE $ I/®
APPROVALS JDATE INSPECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK �� f
TOTAL.FEE ROUGH PLUMBING
GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION . GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY "
PWITH ALL LUMBING. COUNTY ORDINANCES AND STATE LAWS REGULATING 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 I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPS UTILITY CO.NOTIFIED
SIGNATURE
OF PERMITTE
FINAL
OF nVMMATION ROBERT A.WOOD, -
M.0, CASK SUPERVISING MECHANICAL.EING'R
M9984RD APR ?-8 5 A 12.00