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13195-17 12.04 APPLICATION FOR PLUMBING PERMIT
DIVISION OF BURDING AND SAFETY
Deportment of County Engineer
County of LOB Angeles BUILDING
WM.J. FOX, COUNTY ENGINEER ADDRESS
CASSATT D.GRIFFIN,SUPT OF BUILDING
LOCALITY
WMAPPLICANT.TQ FILL M EAST
CROSS ST.
OWNERDISTRICT NO. IF GROUP I ZONE READY FOR INSPECTION
MAIL
ADDRESS
� oC
INDUSTRIAL
CITY TEL.NO WASTE APPROVAL
PLUMBER INSPECTION RECORD
ADDRESS
CITY T `
LICENSE NO.
NUMBER •TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET)
BATH TUB
SHOWER
LAVATORY (WASH BASIN)
KITCHEN SINK
DISHWASHER
LAUNDRY TUB OR TRAY
CLOTHES WASHER
TOTAL NO. ® 0.80 (�® APPROVALS
rL01� DATE INSPEBTOR'S SIGNATURE
GAS SYSTEM=/—OUTLETS Q 1.00
3 1 ,
WATER HEATER ® 1.00 UNDEftAh-pfWORK
ROUGH PLUMBING t3 PO
PERMIT S I 1 00 GAS PIPING
TOTAL FEE pv GAS VENT
1 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 PLUMBING FIXTURES
PLUMBING.
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST 31'
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF UTILITY CO. NOTIFIED
CALIFORNIA OR THAT I AM THE LEGAL WNER OF ABOVE
DESCRIBED RESIDENTIAL PROPERTY. 1
SIGNATURE
FPERMITTE FINAL 'S"� �' !!<'r�.r/
WILLIAM J.FOX,COUNTY ENGINEER VALIDATION
15 '6 5S NAR 14 3 2.60 �
BY
� , DEPUTY