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DBS- oss APPLICATION FOR PLUMBING PERMIT 1
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DIVISION OF BUILDING AND SAFETY
Deportment of County Engineer /�
County of Los Angeles noo Ess S c2 1.�n v wtl w A.
JOHN A. LAMBIE. COUNTY ENGINEER
CASSATT D. GRIFFIN, SUPT OF BUILDI'No 7
LOCALITY /1t ll.✓
I
FOR APPLICANT TO FILL IN I NEAREST
cRosS ST. D S L
OWNER ( DISTRICT NO. GROUP ZONE REAPY FOR INSPECTION
MAILI /-7I
ADDRESS
INDUSTRIAL
CITY TEL. NO. WASTEAPPROVAL
PLUMBER ,(1 -� w v �. %a�+,6oT C INSPECTION RECORD
ADDRESS 01 SLI�Z LY] V64+4PY �-. /a Cl
CITY G TEL NO i,'7' /v
LICENSE NO. �/ 3 `AG T
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET) @ $1.00 0 - tr- S tZ t
BATHTUB @ $1.00
SHOWER @ $1.00
LAVATORY (WASH BASIN) @ $1.00 D
KITCHEN SINK @ $1.00 '9 '
DISHWASHER @ $1.00
LAUNDRY TUB OR TRAY @ $1.00 DC7
CLOTHES WASHER @ $1.00
WATER HEATER @ $1.00 O
GAS SYSTEM @ $1.00 O
APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT 8
ROUGH PLUMBING
7 00
GAS PIPING
TOTAL FEE
GAS VENT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IT HOT WATER HEATER
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES
PLUMBING.
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST h 'i;i
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF t
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE UTILITY CO. NOTIFIED /
DESCRIBED RESIDENTIAL RTY. s
;f 1
SIGNATURE ;...• `� ,.
OF PERMITTE " FINAL
J'
JOHN A. LAMBIE. COU TY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
01. N.P. CASH
�i 2 1 7 O�:; SEP 1 1 3 1 0.0 0 n
76AG67 CE617-3-57
APPLICATION FOR PLUMBING PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
JOHN A. LAMBIE. COUNTY ENGINEER
CA SSATT D. GRIFFIN, SUPT of BUILDING LOCALITY T ��/ l/- /;
FOR APPLICANT TO FILL IN NEAREST
CROSSST. ' T•%::r ,r f� r', e"
NUMBER FIXTURE OR ITEM
OWNER rr�T ✓
WATER CLOSET MAIL
BATH TUB ADDRESS
SHOWER CITY TEL.NO.
LAVATORY CONTRACTOR ('
SINK ADDRESS j, S 3 ��'�� / 7 '•`��
DISHWASHER CITY f L ,744,7-TEL.NO. �, J,�"• ,rr,
LAUNDRY TUB CONTRACTO 'S C.r s, STATE
REGISTRATION NO. / G COUNTY 14
CLOTHES WASHER
DISTRIC IFROUE L ZONE REPUY FOB INS PECLIO.Y
WATER HEATER
GAS SYSTEM C) / INDUSTRIAL
WASTE APPROVAL '
INSPECTION RECORD
l L
1'J
APPROVALS
@ S1.00 PER ITEM ((�� DATE INSPECTOR'S SIGNATURE
OR FIXTURE 5 / 00 UNDER SLAB WORK
ROUGH PLUMBING
PERMIT S 1 00
GAS PIPING
TOTALFEE Ate) GAS VENT
I HEREBY ACKNOWLEDGE THAT I 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 I AM PROPERLY REGISTERED AND GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY ANO STATE OF K
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE1 UTILITY CO. NOTIFIED K
DESCRIBED RESIDENTII, L PRO RTY. 1111. G
SIGNATURE
OF PERMITTEE w'� h� l� •':'r.o/I � 1� FINAL X
0, VVALIDATI ROEEVISINERT WOOD,
SUPERRVISING MECHANICAL ENG'ft
CK, M.O. [ASH
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