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APPL
ICATION FOR PLUMBING PERMIT
D 0 j B O CR oUNTY NGINERRN ADDRESS
WILLIAM A JENSRN SUPT OF BUILOI Na
LOCALITY
FOR APPLICANT TO FUl IN NEAREST
NUMBER FIXTURE OR ITEM
ST
OWNS R
WATT CLOS MAIL.
RRTH TOA ADDRESS
BROW® TE. NO.
CONTRACTOR-
LAVATORY
ONTRACTO LAVATORY
Sm ADDR®8.�1 SLO
DISHWA® TEL NOe�V43-COXVLACTOWS
�f
LAUNDRY TOB REGISTRATION No G o .�t 7�COONTT
CLOTHES WAS DI�iRICT(i0 GROUP ZONE P ED BY
WATER HEATER (�'Ur0
OAS SYSTEM INDUSTRIAL
WASTE APPROVAL
]INSPECTION 118f,'ORD
O
U
g ° S 00DB s ref o v
APPROVALS DATE INSPECTOR 3 SIGNATURE
PERMIT Z Y 00 UNDER ELAS WORK
TOTAL FEE O ROUGH PLUMBING
' �
OAS PIPING 0=4f a
1HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT
ARD STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING NOT WATER HEATER
1 NERENT CIRTIFT THAT 1 AN PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
UCINSEO AS REQUIRED BY I" ANGELES COUNTY AND STATE OF GAS�� 17
CALIFORNIA ON THAT 1 AM THE LEGAL OWNER OF THE AHOY[
DESCRIBED RESIDENT PROP UTILITY CO NOTIFIED
SIGNATURE
OP PERMS FINAL
m. GVALIDATION ROBERT A WOOD,
f M 0. RAYS SUPRRVISWG MKOHMICAL ENWR
Lf_o7103MAY15 5 n 1000