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76A667 17 a 49® 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 I ZONE PER IT NO
PLUMBER RECEIVED BY READY FOR DATE ISSUff
FIRST INSPECTION /� �
ADDRESS
BUILDING
CITY TEL NO g� ADDRESS w
COUNTY (; l / LOCALITY
LICENSE NO 7 O ✓ EXPIRES In �� �J
NEAREST CA
PERMIT FEES CROSS ST
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER
MAIL �+
WATER CLOSET (TOILET) Q O 50 $ ADDRES
BATH TUB Q O 50 CITY TEL NO
SHOWER @ O 50 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THI6
LAVATORY (WASH BASIN) Q O 50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
KITCHEN SINK @ O 50 STATE LAWS REGULATING PLUMBING
1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY Q O 50 ANGELES COUNTY LICENSE OR I AMTHE LEGAL OWNER
OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
GAS SYSTEM-2—OUTLETS @ O 50 SIGNATURE OF L .(2
0
WATER HEATER Q O 50 PERMITTEE s6l/Cd '
SLOP SINK Q O 50 INSPECTION RECORD
FLOOR SINK Q O 50
FLOOR DRAIN Q O 50
c
DISHWASHER Q 0 50
DRINKING FOUNTAIN Q O 50
URINAL Q O SO ..I
HOUSE SEVER @ O 50 Q
Z
MISCELLANEOUS F3
O
APPROVALS
DATE INSPECTOR S NAME
ROUGH PLUMBING
GAS PIPING
i
GAS VENT
CESSPOOL Q 1 00 CESSPOOL V
SEPTIC TANK I SEPTIC TANK
DRAIN ( ) PIT ( ) Q 1 00 SEWER
PERMIT 1 00 GAS TEST //
TOTAL FEE $
UTILITY CO NOTIFIED „ ��yam ('?✓
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