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0:%17'DMSION OFBLIDCAATNO AN FOR -FETY PLUMBINGpPERMIT
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Dep=bnmt of Couaty EnBlaaer
County of Los Angel"
WM J FOX COUNTY ENGINEER ADDRESS
CASSATTO GRIFFIN SUProt OUILOINO
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
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_OWNER /M�/��/� � DISTRICT I GRO P I �{Z N READY i0[IN[iett 10N
MAIL ff
ADDRESS
INDUSTRIAL
CITY TEL NO WASTE APPROVAL
PLUMBER BAXTER & SON INSPECTION RECORD
ADDRESS 2536 N. San Gabriel
S.
an Gabnel
CITY TEL NO /� � 5
LICENSE NO O/
v
NUMBER TYPE OF FIXTURE OR ITEM I[[
WATER CLOSET (TOILET) S
BATHTUB [r[/
SHOWER
r LAVATORY (WASH BASIN)
KITCHEN SINK
DISHWASHER
LAUNDRY TUB OR TRAY
CLOTHES WASHER
TOTAL NO ® �AOP - APPROVALS
/ DATE IN SP CTOR S SIGNATURE
GASSYSTEM OUTLETS OD 100
UNDER SLAB WORK LAO-
WATERHEATER 100
PERMIT 00
ROUGH PLUMBING
f 1
GAS PIPING
TOTAL FEE O GAS VENT
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION HOT WATER HEATER
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING LUMBING F IXTUR ES
PLU BRING
I HEREBY CERTIFY THAT 1 P L G RED A /OR STEST Z
LICENSED AS REQUIRED OS EL AND S E OF
CALIFORNIA OR THAT A LEG R ABOVE TILITY CO NOTIFIED AL
DESCRIBED flES10EN P TY
SIGNATURE 1
OF PERMITTEE FINAL �L
USE
WILLIAM J FOX COUNTY ENGINQER VALIDATION R A WOOD CHIEF PLSG INSPECTOR
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