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_ v DEPARTMENT OF COUNTY ENGINEER PLUMBING 1
bIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
BUILDING
WILLIAM J. FOX, COUNTY ENGINEER ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDINEAREST
ADDRESS .� /�OI `%l/ �y '�"'� CROSS ST. Y �✓
3
DISTRICT NO. GROUP ZONE PERMIT N0.
LOCALITYNEAREST
CROSS ST. L�1�.Q_ RECEIVED} YD Ready for Inspection DATE ISSUED
OWNER C-'
MAIL � -. ,6INDUSTRIAL
ADDRESS 1 /y, �//�/ IJ WASTE APPROVAL
CITY ��,,, - •- , TEL.N0. 6 INSPECTION RECORD
PLUMBER eq (:,6.
ADDRESS
CITY TEL.NO.
�j ['STATE
LICENSE NO. 91F6 /1 ❑COUNTY
J
PERMIT FEES a
_z
NUMBER TYPE OF FIXTURE OR ITEM FEE (D
WATER CLOSET(TOILET) @ 0.80 $ D:
BATH TUB @ 0.80
SHOWER @ 0.80
LAVATORY(WASH BASIN) @ 0.80
KITCHEN SINK @ 0.80 py
LAUNDRY TUB OR TRAY @ 0.80
SLOP SINK @ 0.80
FLOOR SINK @ 0.80
FLOOR DRAIN @ 0.80
DISHWASHER @ 0.80
DRINKING FOUNTAIN @ 0.80
URINAL @ 0.80
GAS SYSTEM..............OUTLETS @ 1.00
WATER HEATER @ 1.00
MISCELLANEOUS
APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT $ 1 00 ROUGH PLUMBING
TOTAL FEE 1 ,S-0
GAS PIPING
IHEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- GAS VENT
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE HOT WATER HEATER
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
REGULATING PLUMBING. PLUMBING FIXTURES
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY GAS TEST
AND STATE OF CALIFORNIA THAT I AM THE LEGAL OWN-
ER OF THE AB V DESR RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE
OF PERMITTEE - _......... - -- - FINAL CQ SS (I
76A667 DBS 17 1/53