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76A667-CP 17%.U/59 TEMPLE CHT
APPLICATION FOR PL.LJMBING PERMIT
DEPARTMENT COUNTY OF LOS ANGELES
OF COUNTY ENGINEER •
BUILDII�iG� NDE,9A�FETYIVISION BUILDING
JOHN A. BI OUNTY NGINEER ADDRESS f
WILLIAM A.JENSEN,SUPT OF BUILDING �
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM
WATER CLOSET OWNER
67
BATH TOB
ADDRESS J
CITY -r.,TM NO. J
SHOWER
LAVATORY CONTRACT
sm ADDRESS
CI
DISHWASHER CITY NO. ^� /
CO C O ' STATE El
LAUNDRY TUB REGIS=TION NO. COUNTY ❑
CLOTHES WASHER DISTRICT NO. GR ONE-_ _ PROCESS BY
WATER HEATEB .
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL /
INSPECTION ORD, yA
' �'✓/PJ"YlY �r•�.- L� _w'f✓C�-�-rf�?Lt��J: �D�'
a $1.00 PER ITE14
/ OR FIXTURE $ I /� APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2100 UNDER SLAB WORK
TOTAL FEE ROUGH PLUMBING4
GAS PIPING
LI BY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIONGAS VENTTE THAI THE ABOVE IS CORRECT AND AGREE TO COMPLYL COUNTY ORDINANCES AND STATE LAWS REGULATINGHOT WATER HEATER
G.EBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
D AS REQUIRED BY LOS ANGELES COUNTY AND STATE' OFGAS TESTNIA OR THAT i AM THE LEGAL OWNER OF THE ABOVEED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIEDURERMITTE FINAL 4 1 �: ll
®v ALIDATION ROBERT A.WOOD,
CAN SUPERVISING MECHANICAL ENG'R
Ulna 4 1 0 8 ,OCT 5 0 3.0 Y^
76AZA 14- -FP
q 817-tREV.I1./78)
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
NUMBER FIXTURE OR ITEM @ FEE ADDRESS
WATER CLOSET LOCALITY
NEAREST n J
BATH TUB 3 CROSS ST. !/
SHOWER OWNER
LAVATORY MAIL
ADDRESS
SINK CITY 15 �1-✓7 ej,0,6 TEL.NO.
DISHWASHER CONTRACTOR
CLOTHES WASHER c
ADDRESS OLD(
rx 026
SWIMMING POOL RECEPTOR
CITY. (�! TEL.NO.
LAWN SPRINKLER SYSTEM STATE / LIC"
WATER.HEATER LICENSE NO. oZce�-7 4' CLASS
GAS SYSTEM OUTLETS DATE INSPECTOR'S SIGNATURE
OUTLETS OVER UNDE SCRB'WORK 'a
5 PER SYSTEM ROUGH PLUMBING
GAS PIPING
GAS VENT Re
HOT WATER HEATER
PLUMBING FIXTURES
GAS TEST
Plan check fee UTILITY CO.NOTIFIED
PLUMBING PERMIT ISSUING FEE$ Q
TOTAL FEE FINAL �—
t PLAN CHECK.VALIDATION
Plan check applicant
Name
Address �� a- 1 0 3,O A
O 010 0 0 5
City Tel.No.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE 2 - - 1600
THAT THE ABOVE ISCORRECT AND AGREE TO COMPLY WITH ALL.000NTY ORDINANCES.
AND-STATE LAWS REGULATING PLUMBING. PERMIT VALIDATION 0'o - 16006
1 HEREBY CER%JFV THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFONA OR THAT I AM THE 0 ,7,'0 1 8 O
LEGAL OWNER OF.AND INE TO RESIDE IN THE ABOVE ES RIBED RESIDENTIAL
PROPERTY.
SIGNATURE
'OF PERMITTEE
DI.STRI(/T NO. PRC ED BYe�
INDUSTRIA .
HASTE APPROVAL _