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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTNIENT OF COUNTY ENGINEER
BUILDING AND gAFETY MSION rJAWDD
iG
JOHN A.�.AMBF>:.COUNTY NGINEER SS 6 12 North Oak Ave.
WILLIAM A.JENSEN,SUP•i of BUILDING
TY Tem le Cit
FOR APPLICANT TO FILL IN T
ST.
NUMBER FIXTURE OR ITEM
omer Anderson
2. WATER CLOSET
1 BATHTUB. S 12 8 82 N. Bess Ave.
1 sxovvER aldwin Park TEL.No. ED 7-2930
LAVATORY CONTRACTOR Belvedere Plumbing Go.
sm ADDRESS 11900 E. Garvey Ave..
DISHWASHER crrY El Monte TEL. No. GI`89836
coNTRAATION 179568 COUNTY 0
LAUNDRY TUB REGISTRATION NO.
1 CLOTHES WASHER D�1CT NO. :rP ' ZONEE D
1 WATER HEATER / Z
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
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fO $1:80 PEE ITEM leyD / 'Ar!r
10 OR rnmv E .I 10.00 APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT 51 P. 00 UNDER SLAB WORK 2-1"Ra D
ROUGH.PLUMBING. 2`f1.0� �
TOTAL FEE 12 OO .
lb
GAS.PIPING -------
ANDHSTATE HEREBY EAT WLIDGE THAT I HAVE RNAD-THIS APPLICATION 01HE ABOVE IS CORRECT-A D AGREE TO COMPLY GAS VENT _ 2/� �'Q O
WITH ALL -COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. HOT WATER HEATER
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURESI 2 /,pQ
LICENSED AS REQUIRED BY LOS ANGELES COUHYY AND STATE OFCALIFOGA TEST
DESCRIBED RESTHIA OR AT I AM THE P OPERTY.LEGAL.OWNER 7HE ABOVE UTILITY CO.NOTIFIE
SIGNATURE
OF PERMITTE
NAL
�Jr VALIDATION ROBE T A.WOOD.
cK. M.O. CASH SUPE ISING MECHANICAL ENG'R
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