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APPLICATION FOR PLU ING PERMN
COUNTY OF LOS ANGE�,��q
DEPAARRTMEGNTANOpF COUNTYDEN TNM BUILDING B o-FNIw�LAFt�I oFu ENIa ON
KKR ADDRESS O ..ti.6�
WILLIAM A JENSEN SUPT of BUILDING LOCALITY
FOR APPLICANT TO FILL IN t- CROSS
BT
NUMBER FIXTURE OR ITEM EACH FE!
OWNER
WATER CLOSER 5195 '2j MAR
RATS TUB 195 ADDRESS
SHOWER 195 CITY TEL No
I LAVATORY T isn r CONTRACTOR
' BINS 195 �•r7 ADDRESS A
DISHWASHER 195 STT(- ) E�T`ELL No 2-d0
LAUNDRY TUB 125 RE6�ATION NO / — / T� COUNTY
CLO11M WASHER I- 1 0 DI ICT OROUF PONE PR C Y
• r
WATER HEATER I so / 0
SAS SYSTEM 4- OUTIl ISO / ,s� INDUSTRIAL a
WASTE APPROVAL O
OUTLETS OVER 5 PER SYSTEM m INSPECTION RECORD n U
73 0
AS �APPRO ALR fS INSPECTOR E SIONA R[
PERMIT i 2 OO UNDER SILAS WORK 0 !n
' ROUGH PLUMBING
TOTAL FEE GAS PIPING )
I M[R[er ADKNOWUl THAT I HAVE READ THI[ APFLICATION GAS VENT � �
ANO STATE THAT THE All IF CORRECT AND ACRE[ TO CONRLr
WITH ALL COUNTY DRDINANCES AND STATE LAWS REOULATINO
PLUMBING HOT WATER HEATER (J-
1 NS[ Y CERTIFY THAT I AN PROPERLY REOISTER[D AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED er LOS ANGELI COUNTY AND STATE OP GAS TEST
CALIFMNIA OR THAT I AN THE LEGAL
OWNER OF AND INTEND TO
RESIDE IN THE AM o DE [D R[BID[NTIA RO"STY UTILITY CO NOTIFIED JK
SIGNATURE
OF PERMITTER,
FINAL
MMATION ROBERT A WOOD
CK o c1SN SUPERVISING MECHANICAL ENO R
102424 JUN 8 5 D 1124~
TBABBT.CE•SIT ~APPLICATION FOR PLUMBIN PERMI
I
COUNTY OF LOS ANGELES
DEP
AHTI1uV'ANT{���0}y�yQC�OU�+N�T•yY�}(�EN�C. _
BJ� Gi_k C OC. LINTY CiNvO1N[[OR AD�
WILLIAM A JENS[N SUPT 0I BUILDING ING
LOCALITY
FOR APPLICANT TO FOS IN
NUMBER FIXTURE OR ITEM EACH FEE OWNER
WATER CLOSET it Rf MAIL
[ATN TUN 125 ADDRESS
SHOWER 125
CITY TEL NO
LAVATORY 125 CONTRACTUS
SINK 125 ADDRESS
DISHWASHER 125CITY TEL NO
COI/TRA TOR B STATE
LAUNDRY TDB 123 REGISTRATION NO COUNTY
CLOTHES WASHER IAS DISTRICT NO GROUP ZONE PROCESSED BY
WATER HEATER 150
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OAS SYSTEM OUTLETS Q.
I� W�1187E APPROVAL O
OUTLETS OVER 3 PES SYSTEM .70 DISPECTTON RECORD lJ
w
0
N
Z
Ad
APPROVALS DATE INSPECTOR a SIONATURE
PERMIT f Z OO UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE GAS PIPING
I H[R[BY ACKNOWLKDO[ THAT I HAV[ READ THIS APPLICATION GAS VENT
AXp STAT[ THAT TVA ABOVE IF GORIER AND AORI[ TO COMPLY
WITH ALL COUNTY ORDINANCE[ ANO RATE LAWS R[OuuTINO HOT WATER HEATER
PLUMBING
I H[RmY CERTIFY THAT I AN PROPERLY R[GIET[IMO AND/OR PLUMBING FIXTURES
LICENELO AS R[OUIR[O BY LOS ANGELES COUNTY AND STATE OF GAB TEST
CALIFORNIA OR THAT I AM THE "GAL OWNER OF AND INTEND TO
RESIO[ IN TH[ABOVE DESCRIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED
SIGNATURE
OF PERMITTEE FINAL
NMATION ROBERT A WOOD
CK o CASH SUPERVISING MECHANICAL ENG R
LACp 2 4 6 0 G JUN 9 5 D .01-
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