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DesS 117 to ssr, APPLICATION FOR PLUMBING PERMIT 1
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DIVISION OF BUILDING AND SAFETY
Department of County Engmeer
County of Los Angeles BUILDING f
JOHN A LAMBIE COUNTY ENGINEER ADDRESS t I/���-e—
CASSATT D GRIFFIN SUP T OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN I NEAREST dd
CROSS ST
OWNER ,. DISTRICT NO G
Z E READY FOR INSPECTION
MAIL
ADDRESS
INDUSTRIAL
CITY It TEL NO WASTE APPROVAL
PLUMBER r , INSPECTION RECORD
7
ADDRESS {' 2
CITY C//�t.G� TEL NO.
LICENSE NO Po o / L
NUMBER TYPE OF FIXT6RE 6R ITEM FEE
WATER CLOSET (TOILET) @ $1 00 $
BATH TUB @ $1 00
SHOWER @ $1 00
LAVATORY (WASH BASIN) @ $1 00
KITCHEN SINK @ $1 00
DISHWASHER @ $100
LAUNDRY TUB OR TRAY @ $1 00
CLOTHES WASHER @ $1 00
WATER HEATER @ $1 00
GAS SYSTEM @ $1 00
APPROVALS
DATE INSPECTOR S SIGNATURE
UNDER SLAB WORK
PERMIT $ 1 00 ROUGH PLUMBING
TOTAL FEE qG
r� 0'0 GAS PIPING (l i
GAS VENT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES
PLUMBING /^� p
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE OVE UTILITY CO NOTIFIED
DESCRIBED RESIDENTIAL PROPERTY
SIGNATURE
OF PERMITTEE FINAL
FINAL --
JOHN A LAMBIE COUNTY ENGINEER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
CK M G CAS `
LAf3�2a7 0° DEC 11 3 200 tr