HomeMy Public PortalAbout9628 BROADWAY_Plumbing__ JAPPLICATION FOR PLUMBING PERMIT I
D..-17 1B-IT DIVISION OF BUILDING AND SAFETY
Department of County Engineer
County of Los Angeles BUILD] [�
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS /
CASSATT D. GRIFFIN, SUPT OF BUILDING I
LOCALITY G 1
FOR APPLICANT TO FILL IN I NEAREST LL
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// CROSS ST. 2Y 1/
OWNER /,/-. d /I C/H S /.0 DISTRICT NO. GROUP ZO READY FOR INSPECTION
ADDRAl LESS0'C /,a FV O cl [1 I.y tI
INDUSTRIAL
CITY G /G es TEL. NO. WASTE APPROVAL
PLUMBER �' S. a ! "i INSPECTION RECORD
ADDRESS // �pp ,o l /O�LUe ✓ (� 1 so Cl-lb-:t
CITY b �e ` •' pTEL. NO[? �p f.f`\C`e-aLl_ls t> �- 1�.��c�..��- /^Af"IA
LICENSE NO.
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NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET) @ $1.00 $ O'O
BATH TUB @ $1.00 O-'d
SHOWER @ $1.00
LAVATORY (WASH BASIN) @ $1.00 (7Y�
KITCHEN SINK @ $1.00 (9 l5
DISHWASHER @ $1.00
1 LAUNDRYTUBOR'TRAY @ $1.00 TJ
CLOTHES WASHER @ 51.00
L WATER HEATER @ S1.00 / O D
GAS SYSTEM @ $1.00
APPROVALS
DATE INSPECTORS SIGNATURE
UNDER SLAB WORK
PERMIT $ i OO ROUGH PLUMBING 25171 -dr'
GAS PIPING
TOTAL FEE X 0
GAS V ENT
1 D HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER
ANSTATE THAT THE ABOVE 15 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/OR GAS TEST .L 5
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL, OWNER OF THE ABOVE UTILITY CO.NOTIFIED k. \
DESCRIBED RESIDENTIAL
VOPEPITY.
SIGNATURE OF PERMITTEE FINAL --
JOHN A. LAMBIE, COUNTY ENGINEERL mATION ROBERT A.WOOD. CHIEF PLBG. INSPECTOR
cs--��m,o. CASH
ileo 6 3 3 3 VAR 25 2 8.0 0 In