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.,OXG87 17 a-so APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES PLUMBING 1
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO./
PLUMBER RECEIVED BY READY FOR DATE ISSUED
- _ FIRST INSPECTION7 ---;
ADDRESS
.._ BUILDING
CITY TEL. NO. ADDRESS- ,.
COUNTY - LOCALITY
LICENSE NO. EXPIRES
NEAREST
PERMIT FEES cRoss sr.
NUMBER I TYPE OF FIXTURE OR ITEM FEE OWNER
j MAIL
r I WATER CLOSET (TOILET) @ 0.50 s -- ADDRESS
BATH TUB @ 0.501 CITY TEL. NO.
SHOWER @ 0.50 I 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
-'I LAVATORY (WASH BASIN) tt 0.50 I APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
--1 KITCHEN SINK @ 0.50 STATE LAWS REGULATING PLUMBING.
1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
Z I LAUNDRY TUB OR TRAY @ 0.50 I ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
OF THE RES]DENT,1-AL,.PROPERTY DESCRIBED ABOVE.
GAS SYSTEM__,3_OUTLETS @ 0.501 -
SIGNATURE ` '-�
WATER HEATER @ 0.501 PERMITTEE � �C..�P{
SLOP SINK @ 0.501
I
INSPECTION RECORD FLOOR SINK @ 0.501
FLOOR DRAIN @ 0.501 J-~'
DISHWASHER @ 0.501 a'Qs -r—.w.gQ-- pec �-�+
DRINKING FOUNTAIN @ 0.501 _� _ A ) �Jyr... �L,�
URINAL @ 0.50 I I -s, "' PA{< I?a,
HOUSE SEWER @ 0.50i i z
MISCELLANEOUS
O
r .¢' 0
I
I
APPROVALS
DATE INSPECTOR'S NAME
1 ROUGH PLUMBING
GAS PIPING
GAS VENT L,
ICESSPOOL @ 1.001 CESSPOOL
SEPTIC TANK: I SEPTIC TANK
DRAIN ( ) PIT ( ) n 1.00 SEWER
PERMIT . . 1,00 GAS TEST
TOTAL FEE
rr` UTILITY CO. NOTIFIED
4$ �
FINAL