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APPLICATION FOR PLUMBING PERMIT 1
COUNTY OF LOS ANGELES
DEPASTD(ENT OF COUNTY ENGDQF�H
MWING AND SAFETY DIVISION eonDDXG
aff D a4Bs�Pnr= ,�,Q ADDaBBe O .2 E12 FILO
TONT m E
FOR APPLICANT TO FILL IN NEAR88T
NUMBER FIXTURE OR ITEM
OWNER
WATER CLOSET MAD
BATH TUB ADDBEBB
SHOWER CRY TEL NO
LAVATORY CONTBIt
BHR ADDRESS 13229 F— Ec+cw Stroof
DISHWASHER CITY cifyOf Indus". ONNO ED, 7.7226
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LAUNDRT TUB RHGIBTRATIOOc
N No 96496 STATE L]ornarr
CLOTHES WASHER DISTR1 O GRRO ZONE PROCESSED BY
/ WATER HEATER
OAS BTBTEM INDGSTRIAL
WASTE APPROVAL
IRSIMMON RECORD
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APPROVALS
Og O DATE INSPEmit'smquTURE
UNDER BLAB WORK
PERMIT E 2 OU ROUGH PLUMBING C
TOTAL FEE Q GAS PIPING* --2—
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COX FLY HOT WATER HEATER
WITH ALL COUNTY ORDINANCES_AND.STATE LAWS REGULATING
PLUMBING PLUMBING FIXTURES
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OH T 1 AM THE LEGAL OWNER OF THE ABOVE UTILITYCO IED
DESCRIBED R�EBI/DT/MyATIAL R0� 3
SIGNATURE'7V i/ FINAL
OF PERMITTE
ROBE.RTA WOOD
®� ETION FUIN
SUPERVISING MECICAL ENG R _
C[ ■ O CASH
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