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APPLICATION FOR PLU BIN,G PE IT ' r
COUNTY OF LOS ANGELES
.DEPARTMENT OF COUNTY ENGINEER
BU�M�DING.AND SAFETY DIVISION BUILDING
CASSA�}T D:G81FF�INC Sup of$�a�'lding ADDRESS. 61 AT a v Oca�f
Lociir= Temple 1ty _
FOR APPLICANT TO.FILL IN NEAREST
,r Longden
NUMBER' FIXTURE OR ITEM
owm Elsie
1 WATER CLOSET MAIL
RAT TUBADDRB$S
CITY _ TEL.NO..
SHOWER
1 LAVATORY - CONTRACTOR $
ADDRESS.
1 mmw/dispDMWASos al P=El Monte TEL: No. GI 4-1559 '
aB;HwEMM s
CONTRACTOR'S STATE
LAUNDRY TOB REGISTRATION NO. 11+9216 cOUNTX'
1: CLOTHES WASHES x DISTRICTNO. I
GR E PRO E D BY
]. . WATER HEATER
1 GAS SYSTM INDUSTIlm
WASTE APPROVAL
" INSPECTION RECORD
4
.S
0 51.00 PER ITEM
nm
7 _ O8 �' '$ .00 APPROVALS DATE. INSPECTOR'S SIGNATURE
4_1 PERMIT $, 2100 UNDER SLAB WORK ! �I
TOTAL FEE (� ROUGH PLUMBING, If
7A 0 `.GAS PIPING O S mA�.P
I HEREBY ACKNOWLEDGE THAT I 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 F
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES — (°jZPt reA
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND: STATE OF GAS'TEST / li
CALIFORNIA -OR THAT I. AM THE LEGAL OWNER. OF THE ABOVE
DESCRIBED SID AL PROPERTY. UTILITY CO.NOTIFIED .
SIGNATURE
OF PERMITAff
� FINAL I.
�R VALIDATION ROBERT A.WOOD,
CBS H.O. CASH SUPERVISING MECHANICAL ENG-Ft
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